Blog Details

A Suite of Solutions: RE-GEN

A Suite of Solutions: RE-GEN

A Suite of Solutions: RE-GEN

Michael A. Miyasaki, DDS

Michael A. Miyasaki, DDS

Familiarizing yourself with an adhesive’s specific properties prior to application is key to a successful restoration. “If not applied properly, imperfect conditions can compromise bond strength and marginal integrity, leading to sensitivity,” Dr. Miyasaki warned. Biologically charged ion placement can help avoid bond degradation, while promoting tissue and bone cell regeneration. Here are some additional highlights of the bioactive products in the RE-GEN suite.

 

Beyond Bioactivity...

ReGen Self Etch AdhesivesRE-GEN Self-Etch system consists of a conditioner, primer, and bonding resin that work in harmony to close any gaps at the resin-dentin interface and prime long-term bond strengths. Protocol takes only 45 seconds.
RE-GEN Universal Adhesive combines the RE-GEN Self-Etch conditioner, primer, and bonding resin into a simple, one-bottle system.
RE-GEN Flowable Composite is formulated with a unique combination of thickness and flow, providing optimal strength (357 MPa) and toughness as well as a high level of radiopacity.
RE-GEN Bulk Fill Composite & Resin Cement is a dual-cure composite that also has features to improve longevity and overall performance, as well as handling characteristics that make it ideal for Class I, II, III, IV, and V restorations.
RE-GEN Pit & Fissure Sealant is a wet bond sealant ideal for use in a moist environment. It is formulated to prevent demineralization and inhibit secondary caries at the margin, ensuring exceptional margin stability.

An experienced clinician with 3 decades of teaching experience under his belt, Dr. Michael A. Miyasaki says his ultimate goal is to increase the success of his colleagues through education. This includes introducing them to new and innovative techniques and products, such as Apex’s RE-GEN product line.

Blog Details

Take the Easy Route to Better Diagnosis

Take the Easy Route to Better Diagnosis

the Easy Route to Better Diagnosis: Schick 33 sensors

Schick 33 Sensor from Dentsply SironaAs a solo GP in Marysville, CA, Charles Kattuah, DDS, just wants a good quality image when it comes to diagnosing caries and other oral conditions. No artifacts or distortion ... just a crisp, detailed image to view and discuss with the patient.

Schick 33 sensors gave me that and more when I decided to purchase them,” he said of his switch to Schick 33 some 8 years ago.

The “more” that Dr. Kattuah mentions cannot be understated. In addition to the unprecedented image resolution, Schick 33 offers broad choices in sensor sizes and cable lengths, allowing clinicians to pick the most appropriate technology for their needs. 

The Kevlar-reinforced, silicon-coated cables help keep the sensor up and running, and the robust sensor interface ensures an extremely durable USB connection. Further, all sensors use replaceable cable technology—available in 3, 6, or 9 feet to fit any operatory.

Enhanced Dental Perception

Backed by expansive system choices and image enhancement capabilities, Schick 33 has the potential to transform patient care. For Dr. Kattuah, having the ability to highlight an area on an x-ray, change the contrast or sharpness by waving the mouse around, zoom in, and measure Schick 33 images has greatly benefitted his ability to diagnose.

“[Schick 33] has definitely lived up to my expectations,” he said.

Great Financing Deals

Fortunately, Schick 33 is now more affordable than ever, with Patterson Dental offering great deals on equipment purchases. Schick 33 and other imaging and operatory equipment are offered for 2.95% interest for 24 months; or 3 months of no interest and no payments. Check out the deals here.

Blog Details

For Orthodontics, the Times They Are a-Changin’

For Orthodontics, the Times They Are a-Changin’

For Orthodontics, the Times They Are a-Changin’

I've seen many changes over the years in the world of orthodontics. When I began my journey in dental school, we had very limited exposure to tooth movement. My biggest concern was whether the Hawley retainer was polished enough to pass the ortho clinical requirements! This lack of training would become apparent in private practice, where many of us considered the referral pad our most valuable orthodontic treatment option.

"Our approach has been to offer our patients the very best care and value for their dental treatment."

cartoon teeth connected with bracesI learned early in my career that I wanted to be a technology disrupter and be proficient in all disciplines of dentistry. That included tooth movement and, by a quirk of fate, I was fortunate to add a satellite dental practice to my primary practice that presented with more than 100 unfinished ortho cases. Realizing my need for education, I took the United States Dental Institute’s orthodontic education program. Soon, with the help of many mentors, I developed an orthodontics-only GP practice.

My primary movement tools were fixed bands and brackets, but I also explored different aspects of tooth movement, including the use of acrylic, functional, and thermoplastic appliances. I discovered many interesting and novel ways to move teeth successfully. Notably, clear thermoplastic aligners made in-house looked like an attractive alternative to bands and brackets.

 

The Changing Marketplace

cartoon teeth being straightened by clear alignersIn 1999, when Align Technology introduced Invisalign, I was the first GP in my area to submit cases, and I soon became one of the first to offer Align’s certification training. The company introduced segmentation software, which creates individual dies of teeth. Based on physics, orthodontic principles, and empirical evidence, tooth movement can be applied and visualized on a computer. Stages are created for the movement, and a virtual model representing the surface morphology of the final tooth positions for each stage can be sent as an STL file to 3D printing software. A 3D-printed plastic model can then be created to serve as the matrix for a thermoplastic appliance or clear aligner.

Today, the marketplace for tooth movement offers many options both for patients and dentists. Do-it-yourself (DIY) systems allow a patient to be treated without a face-to-face consult with the treating doctor. On the other hand, with the advent of easy-to-use, affordable segmentation software, GPs can compete directly with these low-cost DIY services. Technologies such as 3D printers are now in many practices and can be used to create in-house clear aligners. Lower lab costs give dentists the competitive edge to offer profitable, lower-cost treatment options to patients, who may feel more comfortable knowing that their regular dentist is supervising the treatment.

 

A Profitable Workflow

Our approach has been to offer our patients the very best care and value for their dental treatment. Our workflow is: 1) patient clinical exam and records, 2) intraoral digital scan, 3) segmentation software, 4) 3D-printed models, 5) vacuum-formed aligner using thermoplastic material, and 6) finish and polish.

With in-house segmentation software available to create virtual tooth movement—and a 3D printer to provide physical plastic models on which vacuum-formed thermoplastic aligners can be easily made—this workflow can be a profitable approach to tooth movement. Today’s GP can deliver in-house clear thermoplastic aligners that provide the very highest level of care to their patients.

 

Perry E. Jones, DDS, MAGD, IADFE

Perry E. Jones, DDS, MAGD, IADFE is a graduate of Virginia Commonwealth University School of Dentistry, where he serves as an Adjunct Faculty Associate Professor. He is co founder of the American Academy of Clear Aligners (AACA) and Founder/President of Mobile Imaging Solutions, an onsite CBCT imaging service. He maintains a general practice in Richmond, VA.

Blog Details

4 Myths About Fluoride Varnish

4 Myths About Fluoride Varnish

Four Myths About Fluoride Varnish

By Amber Auger RDH, MPH


Amber Auger, RDH, MPH

Amber Auger, RDH, MPH, is a hygienist with experience in multiple clinical settings, including facilities abroad. Amber obtained a master’s degree in public health from the University of New England and a bachelor’s in dental hygiene from the University of New Haven. She holds a part-time position at an elite dental office in Boston, and is chief of clinical technology for Jameson Management. Amber Auger is a key opinion leader for several dental companies, speaker and published author, and can be contacted at amberaugerrdh.com.

 

 

As a practicing hygienist, I come across a lot of misconceptions about treatment options, especially fluoride varnish.

Here are the top four myths I’ve heard about fluoride varnish and what you need to know:

 

Myth #1: It’s all about the flavor

From Salted Caramel to Tutti Frutti, fluoride varnishes are available in a dizzying array of flavors. While great taste can help increase case acceptance, it is not the only factor to keep in mind when selecting a fluoride varnish. Consider the other ingredients in the varnish and the role they play in reducing the risk of dental decay.

Myth #2: Fluoride is the key ingredient

Fluoride is one of several important ingredients to look for in a fluoride varnish, including:

Calcium and Phosphate
During demineralization it is calcium and phosphate ions, not fluoride, that are released by the tooth. When the process of demineralization happens more quickly than remineralization, subsurface lesions develop, leaving the patient susceptible to tooth decay. The appearance of a white spot lesion indicates that, while subsurface mineral content has been lost, there is still potential for remineralization. The combination of calcium, phosphate, and fluoride help support remineralization and preserve tooth structure.

Xylitol
Xylitol promotes an increased salivary flow and a balanced pH which work to reduce the number of cariogenic and periodontopathic bacteria. The use of xylitol has been shown to lead to a reduction in the proportion of streptococci mutants in plaque, neutralize plaque acids, and help remineralize white-spot lesions.

Click here to learn about fluoride varnish with calcium, phosphate, fluoride, and xylitol.

Myth #3: More is better

Counterintuitive as it may seem, using more fluoride varnish is not necessarily better. Patients tend to be less compliant when they have multiple layers of fluoride varnish on their teeth.
Some may even chip away at a varnish treatment that feels “thick” or uncomfortable. To ensure patient compliance, the varnish should be uniformly mixed and placed in a thin, even layer, so that it can dry quickly.

Myth #4: Parts Per Million (PPM) Determines Efficacy

Many varnishes contain a high concentration of parts per million of fluoride (usually 22,600 PPM) in order to extend the contact time between fluoride and tooth surfaces. Research shows that it is the mechanism of action, rather than the parts per million of fluoride ions, that matters most. This mechanism involves interaction of fluoride from the varnish with saliva to form calcium fluoride (CaF2). The CaF2 deposits slowly release fluoride ions into the oral environment, supporting the natural remineralization process.

Interested in learning more about hygiene and prevention?

Join the Embrace Prevention Facebook Group to engage with dental hygiene professionals from all over the world. Click here to join Embrace Prevention on Facebook.

References

Collins, Fiona. The Development and Utilization of Fluoride Varnish. 2014. Available at: https://www.dentalacademyofce.com/courses/2093/PDF/1106cei_varnish_web4.pdf.  Accessed October 23, 2018.
Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit xylitol campaign, a new approach in oral health promotion. Community Dent Health. 1995;12:230–234.[PubMed]

A Maguire, A J Rugg-Gunn. Xylitol and caries prevention — is it a magic bullet? British Dental Journal volume194, pages429–436 (26 April 2003)
Gold, J. Fluoride Varnish Products in the U.S. Market. J Res Development 2013. DOI: 104172/2311-3278.1000e102. Accessed November 6, 2018.

 

Blog Details

Bioactive Cementation: Direct from the Operatory

Bioactive Cementation: Direct from the Operatory

Direct from the Operatory: Bioactive Cementation

Dr. Todd Snyder


Dr. Todd Snyder received his doctorate from the UCLA School of Dentistry and trained at the F.A.C.E. institute. He is an Accredited Fellow of the American Academy of Cosmetic Dentistry, a Member of the American Society for Dental Aesthetics and a member of Catapult Education. Dr. Snyder created and co-direct at UCLA the first two-year graduate program in Aesthetic and Cosmetic Restorative Dentistry. He lectures internationally and has authored numerous articles in publications worldwide. Dr Snyder is a consultant for numerous companies and has his own online training program known as Legion Pride. Dr Snyder also owns two software companies, is a professional race car driver and entrepreneur.

 

In the following case, Dr. Todd Snyder shows how he replaced crowns on teeth #8 and #9 using ACTIVA BioACTIVE-Cement.

Patient's smile before procedure

Pre Op Retracted View

matching shade with front teeth

final preparation before replacing crowns

Heatwave impresion tray with pvs impression material

bite registration using dmg luxabite

retractedd view of provisionals after using Bead line technique

provisional restoration

Applying Activa Bioactive Cement to the crown

retracted view of teeth after cementation with activa bioactive cement

retracted view after cementation using bisco all bond

Cemented Crowns on #8 and #9

Post op smile showing new crowns and veneers

retracted view of new restorations one week later

 

 

 

 

 

Blog Details

Heroic Dentistry: Trauma, External Resorption, Extraction, and Splinting the Natural Crown with ACTIVA

Heroic Dentistry: Trauma, External Resorption, Extraction, and Splinting the Natural Crown with ACTIVA

Heroic Dentistry: Trauma, External Resorption, Extraction, and Splinting the Natural Crown with ACTIVA

Dr. Lukasz Balcerzak

Dr. Lukasz Balcerzak
The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.

 

Adam has been my patient since I started in private practice 16 years ago. Now 28 years old, he is a delightful but seriously compromised young man who has been confined to a wheelchair all his life.

This chapter of Adam’s dental story began in 2012 when he took a fall from his wheelchair and broke his upper central incisors #11 and 21 (8 and 9). With his face bloodied, and with the help of the local police, he arrived at my office, and I repositioned both teeth and secured them with a composite split. A few days later, I performed endodontic treatments.

cracked crown due to external resoprtion on tooth #11

All was well until August 2018 when a radiograph showed massive external resorption in tooth #11 (8). Beyond repair, we waited for the inevitable, and in November 2018, the crown of #11 (8) broke beneath the gum line.

My oral surgeon spent an hour carefully removing the root to minimize damage to the bone. I kept the crown of the tooth stored in sodium hypochlorite, and I decided that the best treatment for Adam was to use his natural tooth for the restoration.

after extraction

Three weeks after the extraction of the root, the natural crown of the tooth was cemented back in its place. For additional support, I connected it to teeth 12 and 21 (7 and 9) with a lingual fiber splint (Angelus) bonded with DenTASTIC UNO adhesive and ACTIVA BioACTIVE-RESTORATIVE (Pulpdent), which has the ideal flow for this indication.

natural tooth crown is cemented to place with flowable composite

It was a long, back-aching appointment, but Adam’s smile was back, his mom was in tears of joy, and for me it was a most rewarding afternoon and what I love most about being a dentist.

final result of front teeth restoration

Dr. Lukasz Balcerzak graduated in 2001 from the Medical University in Poznan, Poland with a specialization in Dentistry. He comes from a family of dental professionals. His grandfather became a dental technician shortly after World War II in Konin, Poland where he practiced well into his eighties. Dr. Balcerzak’s mother, Hanna Szymanska Balcerzak, is also an alumna of Poznan’s Medical University with many years of experience in her specialty, prosthetics. Together with his mother, Dr. Balcerzak’s practice, B & S-DENT, employs a team of dentists each with his or her own specialty. The practice’s motto is “SAVE THAT TOOTH.”

Dr. Balcerzak has participated in domestic and international conferences, lectures, seminars, and dental courses. Dr. Balcerzak is the author of many dental articles, with a particular focus on bioactive materials, and organizes workshops in Poland to teach dentists how to optimally use bioactive materials in their practices.

Blog Details

Streamline Inventory and Grow Your Practice with a Smart, Single-Shade Composite

Streamline Inventory and Grow Your Practice with a Smart, Single-Shade Composite

grow your practice and better serve patients with Omnichroma

Like most businesses, growing your dental practice’s profits means increasing production while keeping overhead in check. But with the steady rise of overhead expenses and stagnant reimbursement rates, this can be an elusive goal.

Inventory management offers a rare opportunity for overhead cost control that can give your bottom line the boost it needs.

On average, supplies account for 5–6% of a practice’s overhead. Without effective inventory management, however, this figure can easily balloon into a burden on your bottom line and productivity. Take for example a practice's composite shade inventory—many times, practices invest in a costly array of shades to match any prospective color of dentition. Unfortunately, some of this product will inevitably go unused or underused, relegated to clutter inventory or expire before needed. And while sorting through shades can prove problematic in and of itself, perhaps even worse is selecting the wrong shade or one that discolors over time or after whitening—this can result in even more loss: of profit, production and patient satisfaction.

Thankfully, manufacturer Tokuyama Dental America offers a brilliant solution to dentists’ shade inventory woes.

Omnichroma CompositeOMNICHROMA®, a new resin-based restorative material, implements the natural phenomenon of structural color to mimic any shade of dentition with just one universal shade. Capable of flawlessly replicating all 16 VITA classical shades and beyond, OMNICHROMA simultaneously simplifies inventory management and procedural workflow, allowing you to affordably and efficiently deliver beautiful, shade-perfect direct restorations.

OMNICHROMA’s exceptional shade-matching abilities are made possible by Tokuyama’s Smart Chromatic Technology, an innovation 35 years in the making. As light passes through the composite’s identical, 260nm spherical fillers, red-to-yellow structural color is generated and blends with reflections of neighboring teeth. OMNICHROMA’s spherical fillers also imbue it with impeccable handling, polishability and strength. The result: a durable restoration with seamless, long-lasting color that’s immune to discoloration and mismatching—even if patients choose to whiten teeth at a later date.

With OMNICHROMA’s single shade, you can eliminate the often-costly guesswork of shade selection, along with the expenses of managing a large shade inventory.

This means no more running out of commonly-used shades, spending money on shades you’ll rarely or never use, and no wasting time searching for the right shade or disappointing patients due to a poor match. All of these practical benefits add up significant overhead and time savings, giving you the freedom to increase production, grow your practice and better serve patients.

To learn more about OMNICHROMA, read user testimonials and request a sample for your practice, visit omnichroma.com/us.

Blog Details

Use of Bioactive Restorative Materials in Patients with High Caries Risk

Use of Bioactive Restorative Materials in Patients with High Caries Risk

Use of Bioactive Restorative Materials in Patients with High Caries Risk

Stefano Daniele, DDS, MSc

 

Stefano Daniele DDS, MSc

 

The focus on prevention has reduced the incidence of caries in many western countries; however, we continue to observe a high rate of dental disease and decay. This is largely due to intrinsic conditions, such as gastro-esophageal reflux and gastric regurgitation (bulimia), and extrinsic dietary causes, such as continuous snacking, high sugar products, and soft-drinks that contain high levels of sugar and acids, which are known to cause aggressive enamel demineralization.1

A 46-year-old male was referred to my office with serious decay and hypersensitivity to cold. His patient history indicated he had undergone stomach constriction surgery to treat obesity. It also revealed a propensity for frequent consumption of a famous carbonated beverage with high erosive potential.2

The patient comes from a middle class socio-economic and cultural background. He is aware of the serious condition of his teeth, but he has no idea of the reasons for his condition. He reported to me that he brushes every day and is careful to practice good oral hygiene, even if he did not schedule regular visits to the dentist. It was only when he experienced hypersensitivity that he took a close look in the mirror and observed the clearly visible damage to his teeth. His major concerns were how this condition affected his smile and the impact of hypersensitivity on his quality of life. He was embarrassed by his teeth, and he could no longer tolerate cold food or drinks.

An initial examination showed large areas of demineralized enamel and exposed dentin, especially in the cervical area (Fig. 1). The extensive caries process could easily be traced to gastric regurgitation as consequence of stomach reduction surgery,3 and the frequent consumption of soft drinks.

I explained these causes and established the treatment plan. The patient was instructed to immediately modify his dietary habits and eliminate soft drinks; he was referred to a gastro-intestinal specialist to address the acid reflux episodes; he was instructed to rinse with sodium bicarbonate solution after each gastric regurgitation episode and avoid tooth-brushing after these episodes to prevent loss of demineralized and fragile superficial enamel;4 and he was placed on a fluoride-based mouthwash regime.

I restored the teeth using a mild self-etch adhesive and a conventional composite resin. However, at a 6-month recall visit, I noticed secondary caries at the restoration margins. Although improvements had been made in the patient’s diet and gastro-esophageal disorder, these had not been fully corrected.

Information on research and advances in dental materials are now readily available through journals, educational programs, and online portals. Through these sources I learned about an esthetic, bioactive, restorative material with a durable resin matrix (ACTIVA, Pulpdent Corporation, Watertown MA, USA). The material releases calcium, phosphate and fluoride ions5 that offer protection to the restorative-tooth interface, which is where secondary caries develops.

I removed the conventional composite restorations on the teeth affected by secondary caries, selectively etched the enamel, applied a self-etch bonding agent, and restored the teeth with ACTIVA (not shown).

At this visit, I observed that a new active carious lesion had developed on the distal of the upper right lateral incisor (Fig. 2). This tooth had not been previously restored, and I treated this lesion with the bioactive material (Fig. 2-6).

The patient is still under my care, and the restorations placed with ACTIVA bioactive material did not show any staining or secondary caries at the one-year recall visit (Fig. 6).

The patient continues to show improvement. The gastro-esophageal regurgitation disorder has been reduced, and the patient follows the prescribed rinsing protocol after each episode. He has completely removed the erosive soft drink from his diet.

Patient history and patient education provide information to both the clinician and the patient that is essential for success. Lifestyle changes and medical interventions may be necessary to achieve desired outcomes. The restorative materials with bioactive properties could be a valid choice – and an alternative to the conventional procedures – in patients exposed to dental erosion, either of an intrinsic or extrinsic nature.

carious process from extended soft drink use

carious lesion developed on the distal upper right lateral incisor

caries removed from tooth

restoration of tooth with activa bioactive restorative and matrix and wedge in place

completed tooth restoration with ACTIVA

ACTIVA restoration

 

 

REFERENCE

1. Carvalho TS, Colon P, Ganss C, Huysmans MC, Lussi A, Schlueter N, Schmalz G, Shellis PR, Björg Tveit A, Wiegand A. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear-diagnosis and management. Swiss Dental Journal 2016:126; 342 – 346.

2. Kitasako Y, Sasaki Y, Takagaki T, Sadr A, Tagami J. Multifactorial logistic regression analysis of factors associated with the incidence of erosive tooth wear among adults at different ages in Tokyo. Clin Oral Investig 2017 Feb 7. doi: 10.1007/s00784-017-2065-7. [Epub ahead of print]

3. Barron RP, Carmichael RP, Marcon MA, Sandor GK. Dental erosion in gastroesophageal reflux disease. J Can Dent Assoc 2003;69:84-89.

4. Yip KH, Smales RJ, Kaidonis JA. Case report: management of tooth tissue loss from intrinsic acid erosion. Eur J Prosthodont Restor Dent 2003;11:101-106.

5. 45. Evaluation of pH, fluoride and calcium release for dental materials. Morrow BR, Brown J, Stewart CW, Garcia-Godoy F. J Dent Res 96 (Spec Iss A) 1359, 2017 (www.iadr.org).

Blog Details

Doctor's Favorites: Direct Restorative Products

Doctor's Favorites: Direct Restorative Products

Favorite Direct Restorative Products

After graduating from the University of Pennsylvania School of Dental Medicine, Michael Teitelbaum, DMD, MAGD, FACD, completed the prosthodontic program at the New York University College of Dentistry. He has practiced family and cosmetic dentistry in Briarcliff Manor, NY, for almost 30 years, and enjoys using the latest dental technology. He is a Fellow in the American College of Dentists, a Master in the Academy of General Dentistry, and lectures nationally on cosmetic dentistry and occlusion. Here, he shares some of his favorite direct restorative products.

For decades, one of the gold standards for excellent, truly beautiful dentistry has been Renamel Microfill by Cosmedent. Designed by legendary cosmetic authority Dr. Bud Mopper to perfectly match the VITA shade guide, this composite system offers proven decades-long color stability.

Omnichroma from tokuyamaA newer entrant in the cosmetic composite market is OMNICHROMA. Tokuyama Dental claims that this one composite (and a blocker when needed) will easily match almost any solid tooth color when used properly. After using OMNICHROMA for a few months, I’ve found the manufacturer’s claim to be true, and I’ve got pictures to prove it. It's almost as if they included chameleon DNA, allowing it to seamlessly blend into any adjacent tooth color.

Whether I'm straightening just a few teeth, uprighting molars for an implant or bridge, or planning a full-mouth alignment, I can simply design Invisalign cases myself or allow Align Technology to do the bulk of the work for me. With expert Invisalign orthodontists on call to help with technical support, it's easy for dentists to offer clear aligners in their practices.

When my reputation is on the line, I need dependable products like DenMat’s Core Paste for post and cores. Flowable to start but quickly hard enough to prep, Core Paste has taken the worry out of core buildups for me for almost 30 years.

I hate remakes, so I try to be accurate the first time. Research shows custom trays help give the most accurate impressions, but why pay a lab for something that's so easy to make in-house? With Dentsply Sirona's Triad Custom Tray material, I can easily make accurate, hard custom trays in just a few minutes for implants, removables, bridges, and even for single-tooth impressions. Triad saves me time and money and helps me provide better dentistry the first time.

Blog Details

Preventive Resin Restoration

Preventive Resin Restoration

Direct from the Operatory: Preventive Resin Restoration

By Dr. Corrado Caporossi

Carious lesions appear most frequently in the pits and fissures of molars and premolars. The dental plaque inside pits and fissures cannot be removed through conventional cleaning techniques used in dental offices or through home care. The morphology of the fissure makes it difficult to diagnose the initial lesion, and surface decay may only become evident when the carious lesion has profoundly progressed beyond the amelodentinal limit.

In the past, clinicians used the “extension for prevention” approach to treat caries in pits and fissures. Thanks to new restorative techniques and bioactive materials, dentists can use minimally invasive approaches for more conservative cavity preparations, such as Preventive Resin Restorations (PRR). PRRs were first described by Simonsen and Stallard in 1977. Now PRRs can be performed with ionic composite resins, which restore the lesions in pits and fissures and help prevent recurrent caries in the rest of the fissure system.

 

Diagnosis of PRR

The clinical diagnosis for PRRs has three primary elements:

  1. 1. Assessment of the patient’s caries risk
    Document the patient’s medical history and perform testing as necessary to determine caries risk.
  2. 2. Diagnosis of lesion depth
    Diagnose enamel lesions and not only cavitated lesions. This is important as the progression of the enamel lesion can be arrested.
  3. 3. Diagnosis of lesion activity
    Both the activity of the lesion and the risk of caries are very important for diagnosis and treatment planning.

Indications for PRR

PRR can be performed on the occlusal surfaces of molars and premolars, buccal fossa of lower molars, and palatal sulcus of upper molars. They are indicated in both temporary and permanent dentition. A PRR is indicated when the carious lesion in the pits and fissures is small and discrete and confined only to the enamel, or when the process has reached the dentin, but without pulpal involvement.

Technique

The methods described above have evolved simultaneously with dental materials and dentin adhesives. The PRR technique involves removing a minimal amount of dental tissue with an air abrasion system with a 29-micron aluminum dioxide powder. Caries removal may not reach the amelodentinal limit and may remain confined to the superficial dentin. In both cases, selective etching should be performed only on the enamel, followed by the application of a bonding agent.

Subsequently, a dual-cure bioactive ionic resin (Activa Restorative Pulpdent) is applied and, after completing an initial 20-30 second self-curing phase, is covered with an oxygen inhibitor and light-cured. If the cavity is deeper, the clinician could use the sandwich technique, which consists of placing a fluid bioactive liner on the floor of the cavity (Activa Base/Liner Pulpdent) and then proceeding with the restorative material.

 

Case Study

A 15-year-old male patient presented with occlusal lesions on teeth #3.6 and #3.7 (#18 and 19) as shown in Figures 1 and 2. He was anesthetized and a rubber dam was placed. Anesthesia and absolute isolation with rubber dam are optional, depending on patient comfort and acceptance. The occlusal surface was cleaned with soft sandblasting, and caries was selectively removed with a small polymeric round bur in a conservative manner without cavity design (Figures 3 and 4). The cavo-surface angle was polished with an abrasive point to eliminate unsupported prisms. Areas of exposed dentin were covered with Teflon tape before selective etching enamel with a 37% orthophosphoric acid gel for 30 seconds. The surface was rinsed with water for 10-20 seconds and dried until it became chalky in color before applying a bonding agent. This was followed by placement of the bioactive resin (ACTIVA BioACTIVE-RESTORATIVE). For best results, allow the resin to self-cure for 20-30 seconds, cover with an air-block gel, and then light cure for 20 seconds on the low intensity setting. After removing the rubber dam, excess material was removed and the occlusion was checked.

Intraoral shot of occlusal lesions

intraoral capture of occlusal lesions on teeth 3.6 and 3.7

caries removed from cavity

prepared teeth after selective caries removal

final tooth restoration

final tooth restoration, full shot

About Dr. Corrado Caporossi

Dr. CaporossiDr. Corrado Caporossi received his degree in Dentistry and Dental Prosthetics at the European University of Madrid in Valencia, Spain where he completed a thesis on “Functional aesthetic rehabilitation in the anterior field with feldaspar ceramic veneers.” He is currently registered with the Order of Physicians and Dentists of Rome and is a member of AIO and ANDI. Dr. Caporossi is also an external professor at the Cardneal Herrera University of Valencia (Es.) and in the master courses of the University of Bari Aldo Moro. He carries out his professional activity in Labico (Rm) in his own dental microscopy center with a particular focus on partial aesthetic rehabilitions. Dr. Caparossi is a speaker at numerous national and international universities where he gives courses of advancement, and at national and international congresses where he discusses aesthetic reconstructive adhesive dentistry with the use of bioactive materials. He provides practical theoretical courses for training in and improvement of multidisciplinary restorative dentistry.

BIBLIOGRAPHY

Barrancos Mooney J. Tratamiento de lesiones incipientes: operatoria dental mínimamente invasiva. En Barrancos Mooney J, Barrancos P, eds. Operatoria dental.Integración clínica.4ª edición. Madrid: Editorial Médica-Panamericana; 2006.
Burke FJ. Restoration of the minimal carious lesion using composite resin. Dent Update 15 1988; 32: 234-232.

Crawford PJ . Sealant restorations (preventive resin restorations). An addition to the NHS armamentarium. Br Dent J 1988; 165:250-253.
Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, SchouS. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res 1998;32: 247-54.
Llodra JC, Baca P, Bravo M. Selladores de fisuras. En: Bascones Martínez A. Tratado de Odontología. Tomo II. Madrid. Smithkline Beecham S A; 1998: 2249-57.
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999; 33: 252-60.
Paterson RC, Watts A, Saunders WP, Pitts NB. Modern concepts in the diagnosis and treatment of fissure caries. Chicago: Quintessence Publishing Co; 1991.
Ripa LW, Wolff MS. Preventive resin restorations: indications, technique, and success. Quintessence Int 1992; 23:307-315.
Swift EJJ. Preventive resin restorations. J Am Dent Assoc 1987; 114:819-821.­
BarrancosMoney J. Tratamiento de lesiones incipientes: operatoria dental mínimamente invasiva. En Barrancos Money J, Barrancos P, eds. Operatoria dental.Integración clínica.4ª edición. Madrid: Editorial Médica-Panamericana; 2006. PRÁCTICA 9 148 Burke FJ.
Restoration of the minimal carious lesion using composite resin. Dent Update 15 1988; 32: 234-232.
Crawford PJ . Sealant restorations (preventive resin restorations). An addition to the NHS armamentarium. Br Dent J 1988; 165:250-253.
Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, SchouS. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res 1998;32: 247-54
Llodra JC, Baca P, Bravo M. Selladores de fisuras. En: Bascones Martínez A. Tratado de Odontología. Tomo II. Madrid. Smithkline Beecham S A; 1998: 2249-57
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999; 33: 252-60
Paterson RC, Watts A, Saunders WP, Pitts NB. Modern concepts in the diagnosis and treatment of fissure caries. Chicago: Quintessence Publishing Co; 1991
Ripa LW, Wolff MS. Preventive resin restorations: indications, technique, and success. Quintessence Int 1992; 23:307-315. Swift EJJ. Simonsen RT, Stallard RE: Sealant restorations utilizing a diluted filled resin: one-year results. Quintessence Int 6:77-84, 1977.

Blog Details

ACTIVA BioACTIVE-CEMENT for a 93-Year-Old Patient

ACTIVA BioACTIVE-CEMENT for a 93-Year-Old Patient

Direct From the Operatory: ACTIVA BioACTIVE-CEMENT for a 93-Year-Old Patient

By Dr. Susan McMahon

Older patients are at increased risk for root caries because of  gingival recession that exposes root surfaces and  increased use of medications that produce xerostomia. Age related visual impairment and decreased dexterity also can lead to higher caries rates and a decreased ability to adequately maintain good oral hygiene. This makes the margins of restorations particularly susceptible to recurrent decay. Choosing a cement that will not only retain the restoration but also help stimulate remineralization is extremely beneficial for these patients.

ACTIVA BioACTIVE-CEMENT helps stimulate apatite formation, supporting the natural remineralization process and helping seal the margin between the tooth and the restoration. ACTIVA helps to prevent microleakage, maintain the integrity of a sealed margin, and keep the restoration, tooth and surrounding tissues healthy.  ACTIVA BioACTIVE-CEMENT is a combination of bioactive resin, rubberized resin and ionomer glass filler.  It is dual cure, moisture tolerant, and indicated for  all indirect restorations except veneers.  ACTIVA is very easy to use, with no additional etching or adhesive steps, and clean-up is simple and quick.

This 93-year-old female patient had mobility in her upper central and lateral incisors. A four-unit splinted HT Zirconia restoration was indicated for functionality and to increase the likelihood of keeping these teeth for the duration of the patient’s life.   Previous PFM crowns were removed and the central and lateral incisors were prepared for a four-unit splinted zirconia restoration.

93 year old patient with mobile central lateral incisors

The patient had +1 mobility on the central and lateral incisors (Figure 1). After removal of the old crowns, the visible areas of demineralization on the central incisors and dark staining on the preps were noted (Figure 2). New splinted crowns would increase a favorable prognosis for these teeth.

Because of the oral health challenges facing geriatric patients (gingival recession, xerostomia, and home care issues), the margins of this new restoration have an increased susceptibility to recurrent decay.  I chose ACTIVA BioACTIVE-CEMENT because of its bioactive properties, which help support the natural remineralization process and seal the margins.

PFMs removed and teeth are prepped for restoration

At the insert appointment, the provisional restoration was removed, the preps were cleaned, and the restoration was tried in. After assuring the fit of the restoration, it was cleaned with Ivoclean, loaded with ACTIVA BioACTIVE-CEMENT, and  seated (Figure 3). The restoration was initially flash cured  to set the excess cement to the gel-like set. The excess cement was then very easily removed (Figure 4). The bioactivity and the ease of use of ACTIVA BioACTIVE-CEMENT make it an excellent choice, not just for geriatric applications like this, but also for many other indirect restorations where recurrent caries is a concern.

easy clean up after flash cure

Dr. Susan McMahon

Dr. Susan McMahon

Dr McMahon, an University of Pittsburgh School of Dental Medicine graduate, is in private practice in Pittsburgh and at University Dental Professionals in Chicago. She is an accredited member of the American Academy of Cosmetic Dentistry, the American Society for Dental Aesthetics, and a fellow in the International Academy of Dental Facial Esthetics. She is the Director of Product Evaluation for Catapult Education and a member of Catapult Speaker’s Bureau. She can be reached at 412.298.2734 or drsusan@wowinsmile.com.

 

Blog Details

Gingival Retraction: Pearls and Pitfalls

Gingival Retraction: Pearls and Pitfalls

Traxodent: fast, predictable retraction & hemostasis without Compromise

Premier Dental's Traxodent Retraction Paste in SyringeWhile adequate gingival retraction is essential to obtaining a quality impression, clinicians should be aware of potential procedural risks and how to avoid them.

First and foremost, the health of patient gingiva and supporting structures should be assessed before attempting retraction. There should be no bleeding upon probing of the gingiva and radiographs should be used to determine if there is sufficient bone supporting soft tissue.1 If either is compromised, the forces of gingival retraction can further damage tissues, so impression-taking should be postponed until tissues are rehabilitated. 

The use of gingival retraction cords is by far the most popular method of tissue management, but these materials pose several significant drawbacks. In addition to being highly technique-sensitive and often time-consuming, using retraction cords can lead to gingival bleeding, patient discomfort and root sensitivity. Likewise, when cords are inappropriately manipulated and/or patients possess thin gingival biotype, further tissue trauma may result, including epithelial attachment damage, exacerbated marginal recession, bleeding and bone resorption.2

Chemicals, either impregnated into gingival retraction cords or in the form of a liquid, gel or paste, can also be utilized to facilitate retraction and hemostasis.

However, like the cords themselves, these agents sometimes produce unintentional, negative outcomes. When placed within the sulcus for under ten minutes, commonly-used hemostatic agents like aluminum chloride and ferric sulfate cause mild tissue trauma. Ferric sulfate, however, has been known to interfere with surface detail of impression materials and discolor patient dentin. Likewise, cords impregnated with racemic epinephrine run the risk of inducing elevated blood pressure and tachycardia, particularly in cases where gingival tissues are lacerated.1 Lastly, each of the aforementioned agents is acidic and therefore may result in postoperative sensitivity.

Gingival retraction pastes, like Premier Dental’s award-winning Traxodent®, offer a more patient- and user-friendly alternative to retraction cords. Traxodent contains 15% aluminum chloride and provides excellent retraction and fluid absorption while remaining gentle on oral tissues. Additionally, the soft, clay-based paste only requires two minutes of contact time, does not necessitate the use of local anesthesia and rinses away easily and cleanly. As a result, Traxodent promotes enhanced ease-of-use and clinical efficiency.

While all methods of retraction, including paste systems, can produce some temporary gingival inflammation, multiple studies show that less traumatic injury to soft tissues occurs when gingival pastes are used as opposed to cord techniques.2,3 This allows Traxodent to achieve fast, predictable retraction and hemostasis without compromising patient health and comfort.

To learn more and purchase Traxodent and other tissue management products for your practice, visit Premier’s website.

References:
https://www.researchgate.net/publication/324680463_Gingival_Retraction_Techniques_A_Review
http://periodontics-prosthodontics.imedpub.com/the-effect-of-gingival-retraction-cord-on-periodontal-health-compared-to-other-gingival-retraction-proceduresa-systematic-review.php?aid=17686
https://www.ncbi.nlm.nih.gov/pubmed/26378615

Promotions