Dentistry Today — September 2023

Inside this issue

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

1. Page 6

   Summer Breeze It's that time of year when you are asked, "So how did you spend your summer?" I hope you had time to actually relax and turn off your dental brains. Maybe you had a few nights of not worrying about "that case" tomorrow at 10 AM. And hopefully you were able to stay cool in this purportedly hottest summer ever. New England, my home, was not spared. Luckily enough to be in a coastal area, and, as many of you know, I take some time going north to the Maine coast. This summer, I was able to spend…

2. Page 8

   VIEWPOINT WNL: Within Normal Limits, or a Dangerous Assumption? Our professional community was rocked by the passing of a young dentist in 2021. Dr. Manu Dua woke up one morning closer to his 31st birthday with the discovery of a lesion on his tongue. He immediately thought that his had possibly bitten his tongue during sleep. He texted a picture of it to his sister, Dr. Arjun Dua, a practicing dentist in New York. She pleaded with him to "get it biopsied." The lesion persisted for months. Biopsy was delayed as Manu, like many of us in the field of…

3. Page 9

   perform routine examinations for oral cancer, including oropharyngeal cancer, for all patients. Based by the ADA House of Delegates, this change was brought about by concerns from the Centers for Disease Control and Prevention (CDC) over the escalating numbers of diagnosed cases of oropharyngeal cancer linked to the human papillomavirus (HPV). The ADA's policy also aligns with support for the HPV vaccine due to the vast majority of oropharyngeal cancers in the United States related to HPV, according to the CDC. We now understand that there are 2 distinct etiologic pathways that bring most people to a diagnosis of oral…

4. Page 10

   The Five Most Common Mistakes Practitioners Make When Taking X-Rays Micah Huish In the rapidly evolving landscape of dental technology, digital x-ray sensors have become an indispensable tool for dental practitioners to capture and interpret radiographic images. Our imaging specialists work one-on-one with doctors and their teams to ensure they get high-quality images for accurate diagnosis. This happens during a dial-in process, where practitioners capture x rays on actual teeth. We fine-tune the image-processing filters to create diagnostic images tailored for optimal quality. After viewing thousands of x-ray images, we consistently see these 5 most common mistakes. No. 1: Cone…

5. Page 12

   Dental Biofilm Melissa K. Turner, chief hygiene officer for Cellerant Consulting, discusses whether biofilm is dentistry's most evil nemesis or the next revolutionary thing. Q: How common is biofilm? A: We educate patients about dental biofilm every hour, every day. Dental biofilm, or what we used to refer to as dental plaque, has its hands in preventive and restorative procedures and is a common factor for oral disease. From implant failures to gingival inflammation and bone loss to imperfect margins and more, oral health professionals live and breathe dental biofilm every day. Much like the antagonist in any good story,…

6. Page 14

   Precision, Innovation, and Digitalization: Dr. John H. Tucker Discusses RAYFace and 3D Imaging Q: Please tell us about yourself and your practice. A: I attended the University of Pittsburgh School of Dental Medicine and graduated in 1982. I am a Diplomate of the American Board of Dental Sleep Medicine and the International Congress of Oral Implantologists. In 2021, I was invited to become an adjunct associate professor at the University of Pittsburgh School of Dental Medicine. My role is to educate the graduate prosthodontic residents regarding sleep-related breathing disorders and oral appliance therapy for the CPAP-intolerant patient. I have a…

7. Page 16

   Glidewell Scanning Solution Includes Portable Cart, Laptop, and Monitor NEWPORT BEACH, Calif.–The fastscan.io Scanning Solution lives up to its name by combining the speed, accuracy, and light weight of the Medit i700 with a seamless connection to Glidewell. Dentists can easily submit cases to Glidewell's lab and save money on each unit for restorations or utilize its open system design to send cases to another lab of choice. The scanner features reversible tips, a detachable cable, and a built-in UV-C LED disinfecting light, plus access to a suite of popular Medit software and apps. Available in wired and wireless scanner…

8. Page 17

   PreXion System Offers Ideal Image Capture for Sleep, Airway Analysis SAN JOSE, Calif.–The 3D Explorer EX 3D CBCT is a unique, large field-of-view model designed for dental professionals seeking high-quality image clarity provided by one of the smallest focal spots available in the industry at just 0.3 mm. The model offers 4 fields of view, including 5 x 5 cm, 10 x 10 cm, 15 x 10 cm, and a single pass with a 15 x 16 cm field of view with no stitch stitching. This large field of view is made possible by the largest TFT type flat panel…

9. Page 18

   LightScalpel Ergonomic Laser Allows for Unmatched Free and Easy Movement BOTHELL, Wash.–The American-made LightScalpel CO2 lasers deliver predictable and repeatable tissue response, fast ablation, and instant hemostasis. The laser's unique ergonomic flexible-fiber-fed pen like handpieces allow for free and easy movement unmatched by other CO2 laser manufacturers. Its high-precision cutting, minimal collateral damage, clear operating field, and minimized postoperative pain make it the tool of choice for soft-tissue procedures, including frenectomies, vestibuloplasties, biopsies, gingivectomies, crown lengthenings, and more. For more information, call (866) 589-2722 or visit lightscalpel.com. ner Creates Realistic, Color Digital Impressions FULLERTON, Calif.–Intraoral scanners are making dental practices…

10. Page 19

    Ray America Scanner Produces Restorations Uniquely Suited for Patients' Faces FORT LEE, NJ—RAYFace is an innovative 3D facial scanner that sets out to completely change the way clinicians think about the patient experience in restorations. As the first 3D facial scanner to accurately superimpose a patient's dentition data with only a single click of the mouse. Rather than relying on an antiquated method of custom impression trays with external scan body contraptions, RAYFace utilizes a patient's dentition information as its unique labial marker to match the data. The end result is comprehensive and complete information on the patient to accurately…

11. Page 20

    Henry Schein One Practice Management System Simplifies Operations AMERICAN FORK, Utah—Dentrix Ascend, Henry Schein One's cloud-based practice management system, helps dentists deliver their best patient care with easy-to-use clinical workflows, high-quality imaging, and the latest AI tools. It simplifies operations and boosts practice profitability with patient communication tools to keep one's schedule full—plus there are proven free tools for easily collecting on insurance claims and patient billing. Dentrix Ascend is easy to learn and use, helping staff set up to speed quickly. For more information, call (844) 588-6473 or visit dentrixascend.com. c Cleaner Evacuation Cleaner Instrument Pre-Soak Ultrasonic Cleaner •…

12. Page 21

    TECHNOLOGY 21 SPOTLIGHT L&R Ultrasonics Strips Provide Checkups for Ultrasonic Cleaners KEARNY, NJ—The UltraDose WaveCheck Ultrasonic Test Monitor Strips (UDo39) have quickly become an industry standout in monitoring the peak performance of one's ultrasonic cleaner and solution. Each strip measures multiple variables of the cleaning process at once. Make WaveCheck part of the infection control protocol and give your machines a checkup at any time. The strips offer quick and easy testing, 50 single-use monitor strips in each box, and a bonus holder. For more information, call (201) 991-5330 or visit ltrasonics.com/contact. USE FREE info card, Aseptico Motor Delivers Power…

13. Page 24

    SureSmile Training and Support Helps Clinicians to Advance With Confidence Erania Brackett is the senior vice president, orthodontic aligner solutions & customer experience, and head of sustainability for Dentsply Sirona. In this role, she is responsible for leading Dentsply Sirona's efforts to enhance the customer experience across multiple areas, including brand management, clinical education, digital marketing, and key opinion leader governance and programs. Additionally, she is responsible for the rapidly growing orthodontic aligner solutions business, including the SureSmile brand. Erania Brackett Q: How would you describe SureSmile from a practice-building standpoint? A: Predictability is the most important consideration for doctors…

14. Page 26

    TruAbutment Software Provides Guide for Digital Restoration Needs IRVINE, Calif.—Users can now access TruSuite and download TRUST, Dentra, MiBuilder, and NGuard for digital restoration needs. The newest release, Pylon, provides an implant guide software, and TRUST allows users to design from scans with Exocad body and export designed STL files for both crowns, and custom abutments at no cost. Users are able to design a full custom abutment and healing abutment, along with the Ti-base design function for implant restoration on TRUST. One of the biggest benefits to the ecosystem is that it is 100% cloud-based, eliminating the use of…

15. Page 28

    Dentsply Sirona Retainer Lasts Longer, Avoids Additional Chair Time ENCINITAS, Calif.–Help prevent patients' teeth from relapsing by providing SureSmile Retainers once they've completed their orthodontic treatment. These retainers can be used on patients who have had their teeth straightened using any type of orthodontic treatment. With SureSmile Retainers, you get the freedom and flexibility to order exactly what your patients need. Whether it's multiple sets of retainers for a patient who just lost his or her orthodontic treat­ment or a single arch replacement for a patient that has lost his or her retainer, SureSmile has that covered. SureSmile Retainers have…

16. Page 29

    Tokuyama Dental America Flowable Composite Simplifies Restorative Procedures ENCINITAS, Calif.-OMNI-CHROMA FLOW, a one-shade flowable composite, follows in the footsteps of OMNI-CHROMA. OMNICHROMA FLOW is capable of matching any of the 16 VITA Classical tooth shades with a single shade of composite. By eliminating the need to shade match or stock multiple shades of composites, OMNI-CHROMA FLOW simplifies restorative procedures and allows dentists to reduce their inventory, saving time and cost. OMNICHROMA FLOW is indicated for Class I through V restorations in anterior and posterior teeth. The following qualities make OMNI-CHROMA FLOW an excellent choice for dentists looking for great cavity…

17. Page 30

    Kuraray America Resin Cement Features Unique Nanocluster Filler Technology NEW YORK–PANAVIA Veneer LC is an advanced, light-cured resin cement with excellent color stability and high bond resistance. It provides ample working time and offers fast and easy cleanup. It is indicated for permanent cementation of aesthetic veneers and can also be used for inlays and onlays less than 2 mm thick. Offering an ideal consistency for easy and secure application across the intaglio surface, PANAVIA Veneer LC does not stick to the application tip due to its unique nanocluster filler technology. This technology consists of spherical silica fillers in the…

18. Page 31

    ArtCraft Dental Instruments Designed for Efficient Retrieval of Broken Root Tips DALLAS-If you struggle with broken root tips in your practice, then try Golden Retrievers. The set consists of the single Spear Elevator and Right and Left Root Tip Picks. The tip sizes and handle designs are specifically sized for the most efficient retrieval of broken root tips and badly decayed retained roots. The palm handle of the Spear Elevator gives the operator maximum power while maintaining a comfortable feel. It can be used as a PDL cutter or a tooth-loosening elevator. The Root Tip Pics are the ideal size…

19. Page 34

    Elevate Oral Care Gel Helps Relieve Dry-Mouth Symptoms, Aid Oral Health WEST PALM BEACH, Fla.–All-day Dry Mouth Gel combats dry mouth differently than any other moisturizing mouth product. Its patented innovation uses a special mucoadhesive hydrogel that works in concert with its maximum xylitol concentration to relieve dry mouth and help improve oral health. Since dry mouth patients are at extremely high risk of getting sick, achieving a non-acidic oral environment is crucial for disease prevention. Alliday Gel is manufactured to a neutral pH of approximately 7.0, providing continuous buffering and protection with use throughout the day and night. Alliday…

20. Page 35

    INNOVATIONS 35 Dentis USA Digital Guide System Provides Guidance for Sinus Procedures LA PALMA, Calif.-SQ Implant fixture was developed based on decades of implant technology and expertise. It's a submerged and qualified system that is easy to install. It's a bone-level implant that maximizes placement, depth control, and fixation power, solving many challenges of implant surgery. Along with SQ implant fixture, SQ Full Guide System is a perfect match for implant surgery key solutions. It's a fast and economical digital guide system that allows dentists to design and fabricate the appliance directly in a dental clinic. Clinicians with long-time experience…

21. Page 36

    Trigeminal Neuralgia 101 The surprising connection between dentistry and neuropathic pain. Q: What is trigeminal neuralgia, and why should dentists care about it? A: Trigeminal neuralgia (TN) is a neuropathic facial pain condition characterized by recurrent, unilateral, brief electric shock-like pain that is abrupt in onset and termination and is triggered by innocuous stimuli, such as gently touching the face, talking, and washing the face. TN has also been called tic douloureux and is relatively common. It is often referred to as an invisible illness as it is impossible to visualize and difficult to diagnose. What we know for sure…

22. Page 38

    Industry News The exocad Webshop Offers Training Services There is a new service for exocad licensees: individual exoplan training sessions. Book with exocad's technical help desk staff at shop.exocad.com. Introductory training sessions are tailored for labs and clinics and offer in-depth knowledge around exocad's implant plan- Learn more at shop.exocad.com. ning and surgical design software. Up to 5 employees can register and participate. The sessions are recorded and available afterward. Training sessions are offered in English and German. Great Lakes Dental Technologies Partners With OrthoApnea Great Lakes is pleased to announce a new partnership with OrthoApnea, the developer of an…

23. Page 42

    New Paradigm for Third Molar Management The Clinical Rationale Behind Fully Guided Third Molar Tooth Bud Ablation Leigh Colby, DDS Clinical management of third molars has remained largely unchanged for the past 100 years. Practitioners' only choices are to surgically intervene prophylactically or address issues after symptoms become evident. In the presence of pathology, the latter approach is painful and costly. Unfortunately, both approaches pose considerable surgical risk. As a result, general practitioners refer more than 80% of third-molar surgeries to specialists. With the evolution of guided implant placement, dentists have an opportunity to reimagine how they manage third molars.…

24. Page 44

    Celebrates its 40-Year Milestone This year marks 40 years of DENTAL ADVISOR offering non-biased, evidence-based, and clinically relevant information on dental restorative products, infection control products, and equipment. What started as a small group of dental professionals who saw a need to share accurate, tested information with manufacturers and dental professionals has evolved into a global organization with more than 300 clinical advisors and a sophisticated biomaterials laboratory with advanced testing capabilities. DENTAL ADVISOR is an industry-disrupting service provider that challenges dental professionals and dental product distributors to push their limits on improving product quality and innovation. Created in 1983,…

25. Page 58

    Review of Exigent Dental Conditions More general practitioners are incorporating dental implant procedures into their practices. Certainly, we are aware that patients present requesting replacement of missing teeth, stabilization, and retention of removable appliances or, in some instances, fabrication of full arch implant prostheses. With the advances in manufacturing and design, implants have become a viable alternative to conventional procedures. Patients request that their trusted dentists perform many of these procedures. However, there are many generalists that may provide prosthetics over dental implants placed elsewhere but refrain from the surgical protocols. The main concern is the position of the mandibular…

26. Page 60

    Contemporary Approach on Sinus Augmentation INTRODUCTION Perforation of the maxillary sinus by a dental implant is a concern for many dental implant clinicians. Maxillary sinus floor elevation (SFE) is used to augment insufficient alveolar bone when placing dental implants in the maxillary posterior region and can be accomplished via a trans-alveolar or a lateral approach.1,2,3 The most common complication during SFE is the perforation of the Schneiderian membrane, with a reported prevalence of 8% to 32%.4-6 The risk factors include the presence of sinus septa, low residual bone height, and smoking.7 Some studies have found that membrane perforation increased the…

27. Page 62

    IMPLANTS [Figure 1. A guide drill marked the osteotomy site.] [Figure 2. A 3.1 mm CAS Drill (Hiossen) with a 4 mm stopper.] [Figure 3. A 4.1 mm CAS Drill with a 4 mm stopper.] [Figure 4. A hydraulic lifter with saline solution used to safely lift the sinus membrane.] [Figure 5. A bone carrier head with a bone condenser was used to fill the sinus cavity with bone graft material.] [Figure 6. Implant placement in the sinus cavity post sinus lift and bone graft insertion.] [Figure 7. Drilling the implant into the osteotomy site.] [Figure 8. Implant placement in…

28. Page 63

    IMPLANTS 63 Figure 9. Wisdom tooth placement and condition. Figure 10. Implantation path and orientation. Figure 11. Implant placement within the sinus cavity after the sinus lift. Figure 12. Placement of a healing abutment to support healing of the gingiva and to create emergence profile. Figure 13. Restoration blending with adjacent tissue. Anesthesia was performed with 2% lidocaine with 1:100,000 epinephrine via infiltration. A subcrestal horizontal incision was made around the area of the first molar to the second molar, and a vertical incision was made on the distal of the first molar. The flap was reflected with the sharp…

29. Page 64

    The Do's and Don'ts of Single-Shade Composites in the Smile Zone INTRODUCTION The art and technique of direct composite restoration of anterior teeth continues to gain popularity with a demand for minimally invasive procedures. Social media is a significant source of information for patients to view the possibilities for anterior restorative options through photographs and videos posted by dentists. For many dentists, the challenge of understanding which composite(s) to use, how to layer it, how to appropriately prepare the tooth, and how to finish and polish the final restoration can be frustrating. Again, social media can be a powerful source…

30. Page 66

    RESTORATIVE FIGURE 1. Extracted lower incisor showing a common type of Class IV fracture. FIGURE 2. Facial and lateral views showing a conservative 45° lingual bevel and micro-air abrasion with 27 um aluminum oxide. FIGURE 3. Only OMNICHROMA (Tokuyama Dental America) was used to restore the entire restoration, which ended up having show-through, and the hard incisal edge was visible, creating an unsatisfactory result. FIGURE 4. Too much OMNICHROMA BLOCKER (Tokuyama Dental America) was used to create the lingual shelf, which went over and onto the facial surface. FIGURE 5. With too much BLOCKER, the final restoration ends up looking…

31. Page 67

    Figure 13. Final OMNICHROMA layer placed using Mylar strips to form proximal contacts and embrasures. Figure 14. Immediate postoperative retracted view of the final restorations. palatal shelf was created with a very thin layer of OMNICHROMA (Figure 11). The BLOCKER was then sculpted to replicate the dentin layer (Figure 12). This was done by feathering the BLOCKER onto the facial bevel just enough to block out the hard fracture line while leaving enough space to place a final layer of OMNICHROMA over the top. A Mylar strip was used to pull the final layer of OMNICHROMA interproximally and shape the…

32. Page 68

    Simple Treatment to Stabilize Incisors After Luxation or Avulsion INTRODUCTION After traumatic injuries to teeth, such as luxation or avulsion, stabilization is of prime importance. Conditions for splints include: 1. Passive, not active, force on a tooth 2. Allowing for physiologic tooth movement 3. No harm to soft tissue 4. Not adversely affecting the occlusion 5. Allowing for endodontic treatment to be performed if needed 6. An easy-to-clean tooth 7. Ease in removing filth from the tooth.1,2 The most common treatment is the use of a flexible splint. Various materials are used, and the treatment is basically the same.3 Another…

33. Page 69

    Keep the retainer on all day except when brushing teeth (28 days) Check the mobility of the tooth after 1, 7, 14, and 21 days In the case of luxation, taking an electric pulp test (EPT) (scale 1 to 10) after 1, 7, 14, and 21 days Checking the mobility of the tooth, percussion, palpation, and probing and taking an EPT and a periapical radiograph after 28 days CASE REPORTS Case 1 The patient was a 5-year-old girl who fell on top of a water bottle while drinking and avulsed the deciduous left lateral incisor. Her childcare worker washed the…

34. Page 70

    Case 2. Figure 2a. Pre op intraoral photograph of displacement. Figure 2b. Periop radiograph of displacement. Figure 2c. Intraoral photograph of the replanted tooth. Figure 2d. Intraoral photograph. The tooth was fixed with light-cured resin. Figure 2e. Working model with a vacuum-formed retainer. Figure 2f. Intraoral photograph. Wearing a vacuum-formed retainer. Figure 2g. Radiograph immediately after replanting. Figure 2h. Intraoral photograph at 28 days post op. Figure 2i. Radiograph at 28 days post op. Figure 2j. Intraoral photograph at 3 months post-op. Figure 2k. Radiograph at 3 months post-op. Figure 2l. Intraoral photograph at 5 months post-op; the sinus tract…

35. Page 72

    The Dentist's Journey With a Sleepy, Tired Child INTRODUCTION The landscape of dentistry is changing, and the topic of airways has been influencing dentistry rapidly. Besides the historical aspects of dentistry, such as preventative, restorative, periodontics, and orthodontics, there are new players in the game. Dental sleep medicine, oral appliance therapy, and integrative medicine are infiltrating the dynamics of dentistry. More so, there is an urgent need for integrative dentistry, which encompasses collaboration, technology, and referrals and is creating a paradigm shift. As a general dentist who became a junkie for all types of CE, I stumbled upon dental sleep…

36. Page 74

    The Dentist's Journey With a... continued from page 72 and a follow-up post FSG sleep study. We started myofunctional therapy right away and saw Julian monthly for 5 months. His initial presentation of a narrow arch and vaulted palate contributed to his mouth breathing habit. The tongue tie and reverse swallow contributed to the tongue thrusting and weak tongue function. After 6 months of functional appliance therapy—and, in his case, using a pre-ortho appliance—he began to sleep better with the appliance in place for the next year. His follow-up ENT appointment, which was one year later, concluded that surgery was…

37. Page 76

    AIRWAY expansion with the Earches and myofunctional therapy was beneficial for the patient. Releasing his posterior tongue tie alongside myofunctional therapy promoted improved nasal breathing and corrected oral habits such as thrusting and malocclusion of his lower anterior teeth. Case 3 Preston was a referral from a colleague close by. He had a history of prior orthodontic expansion and was dealing with anxiety and poor sleep patterns. He had a tongue-tie release as a baby, and his mom stated she had difficulty nursing. A previous consultation with a new dental provider recommended extractions of permanent teeth Nos. 5, 12, 21,…

38. Page 77

    Smile Makeover With Direct Composite Veneers INTRODUCTION When it comes to executing a smile makeover, dentists have a variety of direct and indirect techniques to consider.¹ With the emphasis today on minimally invasive techniques to preserve tooth structure and demand from patients for a natural-looking treatment result, direct resin composites have catapulted to the forefront as a method to save as much tooth structure as possible while providing the patient with long-lasting, highly aesthetic restorations that blend seamlessly in the mouth.2,3 Whether repairing enamel defects or a fracture on a single central, closing a diastema; or improving aesthetics by altering…

39. Page 78

    Figure 2. An intraoral scan of both arches revealed a constricted bite with slide wear on teeth Nos. 7 to 10 and chipping on teeth Nos. 8 and 9 caused by intrusion with the patient's lower teeth and a large diastema. Figure 3. Prior to direct resin composite restorative treatment for veneers on teeth Nos. 4 to 13, clear aligner therapy was prescribed for both arches to flare the anterior teeth forward to create a non-intrusive relationship. Figure 4. After 15 weeks of aligner therapy, the anterior relationship had been corrected, and the 4 mm diastema between teeth Nos. 8…

40. Page 80

    Smile Makeover With Direct... continued from page 78 tooth No. 8, a thin layer of skin shade was applied onto the lingual matrix and placed onto the tooth. The layer was held in place and cured. Next, a thin layer of Bll dentin was placed over the facial aspect and light cured to establish the correct length and desired shape (Figure 12). In order to establish the final white color of the composite veneers, the last layer placed was the skin bleach shade, then it was cured. A cutback window technique was used to create the space needed to apply…

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