Henry Schein Dental Solutions Nov-Dec 2023 by Henry Schein Australia

D E N TA L S O L U T I O N S

NOV / DEC 2023

CONTENTS - CLICK CATEGORY TO VIEW DENTAL EDUCATION HUB

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PREVENTATIVE

ORTHODONTICS

COSMETIC & RESTORATIVE

PRACTICE GREEN 14

PAIN CONTROL

ENDODONTICS 50

INFECTION CONTROL

HANDPIECES 58

INSTRUMENTS 68

DENTAL SOLUTIONS

WELCOME TO OUR NOVEMBER / DECEMBER DENTAL SOLUTIONS Welcome to the final edition of Dental Solutions for 2023 following an eventful few months particularly with FDI World Congress making a grand return to Sydney after more than a decade. With over 10,000 attendees, both local and international, the event was a melting pot of education and innovations. One standout moment for us was the presentation by Michael Fahey, the Commercial Director of Henry Schein and the President of ADIA NSW, on the crucial topic of Sustainability in Healthcare.

As we reflect on Michael's impactful discourse, it is clear that there is a tangible way we can collectively make a difference—by focusing on reducing emissions and packaging through order consolidation. Astonishingly, 18% of Henry Schein's customers place orders five or more times a month, contributing to a staggering 50% of emissions. That equates to 484 tonnes of carbon, 1.1 tonnes of paper, and 170 kilograms of plastics. On the flip side, the remaining 82% of customers have an equal impact. How frequently does your practice contribute to this pattern? The solution lies in the simplicity of HenrySchein.com.au. By strategically planning and building your shopping cart throughout the month, you can reduce the number of orders from five to one or two. A mere reduction of one delivery per month can translates to a 10% decrease in our environmental impact. Not only does this benefit the planet, but it also allows you to take advantage of freight-free limits, plus maximizing payment terms by placing your order at the start of the calendar month.

The launch of Practice Green earlier this year underscores Henry Schein's commitment to sustainable distribution. From energy-efficient LED lighting and solar panels to water harvesting and waste diversion, our efforts are already starting to make an impact. As a Group we have reduced printing by nearly 1 million pages per annum, switched to renewable packaging, and are working towards a 15% reduction in courier-related emissions by 2025. Our journey towards sustainability doesn't end there. Our procurement and warehouse teams are tirelessly reviewing packaging usage, aiming to transition all remaining bleached white boxes to brown recycled packaging. We are also experimenting with alternatives for plastic filler and tape, exploring recyclable materials for a greener approach and satchels for smaller deliveries. In this edition, delve deeper into the world of sustainability with a spotlight on Beaconsfield Dental in Victoria. They are setting an inspiring example, going above and beyond to minimize their environmental impact. Turn to page 14 for an inside look into their remarkable journey.

DID YOU KNOW? A SNAIL’S MOUTH IS NO LARGER THAN THE HEAD OF A PIN, YET IT CAN CONTAIN OVER 25,000 TEETH

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DENTAL EDUCATION HUB

CPD COURSES AND EVENTS FREE GO-TO RESOURCE FOR DENTAL EDUCATION AND CPD

Explore over 270 hours of clinical and business related content all in one place with access to courses, webinars, podcasts and articles. View our upcoming courses and webinars below

Getting the best out of your rotary instrumentation for successful endodontic outcomes

Endodontics Unpacked

Dr. Gaurav Vasudeva Wednesday 1 November 2023 1 CPD point

Dr. Harry Mohan Friday 17 November 2023 8 CPD points

Q3 Webinar Week - On Demand

Q4 Webinar Week - On Demand

Uncover August’s missed webinars Watch on demand now

Discover missed webinars Watch on demand now

RELY ON US

Celebrating Excellence in our Workplace Culture

We've made it easier to shop online

Henry Schein is delighted to announce our latest achievement as one of Australia's esteemed 2023 Best Workplaces™. This achievement is a testament to our unwavering commitment to nurturing a positive workplace culture that empowers every member of our team. Earlier this year, Henry Schein Australia proudly marked a significant milestone by receiving its Great Place to Work® Australian certification for the fourth consecutive year. This certification is a globally recognised symbol of excellence in workplace culture, acknowledging companies that prioritise the creation of high-trust environments where all employees can flourish.

Henry Schein continues to undergo a series of website improvements aimed at enhancing user experience and making it simpler and easier to shop with Henry Schein. These changes are driven by a strong commitment to customer satisfaction and convenience, reshaping the way users shop via Henry Schein Online and driven by user feedback and input. Henry Schein has invested significantly in AI-driven technology to offer customers personalised recommendations. These are designed to save time in the procurement process by suggesting the right products when they are needed. The Search user interface has been revamped to be more user-friendly and efficient. Users can now make direct purchases from search result previews, apply multiple brand and category filters to narrow down product choices, and easily search within their favourite or previously purchased items. Additionally, search results have been optimised to display stock status, product images, and items on promotion more prominently, ultimately making it easier and faster for customers to find what they need.

As we reflect on our journey, we not only continue to celebrate our distinguished status as a Great Place to Work®, but we are also deeply humbled by our 8th position in the medium size organisation category ranking by Great Place to Work® Australia. This achievement serves as a testament to our ongoing dedication to providing an exceptional workplace experience, reinforcing our commitment to our valued employees.

In conclusion, these transformative changes at Henry Schein demonstrate our ongoing dedication to improving the user experience and to serving the evolving needs of healthcare professionals. Over the coming months you will see further improvements to the user interface particularly during the checkout process and when browsing for promotional items and search results.

At Henry Schein, we are committed to fostering a positive and supportive work environment that is not just about recognition; it's about the well-being and growth of our team members. We remain resolute in our mission to create a workplace where individuals can thrive, contribute their best, and build a rewarding career.

What's it like to work for Henry Schein

View the Henry Schein Website

CLICK HERE

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ORTHODONTIC SOLUTIONS

REVEAL CLEAR ALIGNERS THE CLEAR CHOICE FOR A BEAUTIFUL SMILE

Reveal is backed by over 40 years of innovative orthodontic solutions and over 200,000 cases globally in recent years. Reveal Clear Aligners offer significant savings compared to the leading in-office aligner brand. Your patients will love having a high-quality aligner, at an affordable price.

Case Description Patient Chief Complaint Narrow upper arch, crowding, cross bite, 15 year old female

Aesthetics and cross bite of upper left 2nd premolar.

Pre Treatment

Treatment Planning Upper arch expansion to correct cross bite and IPR in upper and lower arches to correct alignment. Number of aligners: Upper 22 Lower 17

Duration of treatment: 12 months No attachments. No revisions.

Final Results

Treatment Notes During-treatment Complications: Patient lost upper 12th aligner during the treatment and was requested to jump on to next aligner. Post-treatment Assessment: Upper left lateral was not completely derotated. This was due to less wear time of aligner no. 12.

ORTHODONTIC SOLUTIONS

Case Description

Patient Chief Complaint

Prominent upper canines, upper midline correction, 31 year old male

Prominent upper canines, upper midline correction.

Pre Treatment

Treatment Planning Accommodate upper canines by moving them distally in to the spaces created by Inter Proximal Reduction (IPR) in posterior teeth.

Number of aligners: Upper 15 Lower 15 Duration of treatment: 9 months No attachments. No revisions.

Final Results

CLICK HERE CASE BOOK

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PREVENTATIVE

EDUCATING OUR PATIENTS ABOUT THE DISEASE-DIET RELATIONSHIP

We know that oral health is associated with diet in many ways, and we can track this back to ancient times. Dental palaeopathology or the study of ancient teeth, reinforces for us, as oral health professionals, the importance of addressing dietary habits and behaviors with our patients. In particular, with the prevention of dental caries, since diet plays a critical role in the development and prevention of this disease. The findings from fossil records show that huntergatherers rarely experienced dental caries (Tanga, Viciano, Monza, D’Anastasio, Capasso, 2020). Diet played an important role in plaque prevention and its association with a higher composition of good bacteria (Forshaw, 2014). The shift in our ancestors diets over time, from this hunter-gather style, which consisted mostly of protein and fats, which are non-cariogenic as oral bacteria cannot ferment them, to an increase in the intake of carbohydrates, particularly sugars, which are cariogenic, has contributed to the increased rates of dental caries for populations across the globe (Forshaw, 2014). Although there are several key factors in the aetiology of dental caries, such as oral bacteria, susceptible tooth surfaces and oral hygiene practices, dental caries is a diet-mediated disease. Sugar, specifically, free sugars are a key dietary factor in the development of this disease (WHO, 2015). Our responsibility as oral health professionals is to address our patients’ dietary habits and provide appropriate dietary advice to help prevent oral disease. Undergraduate dental training can sometimes be limited in the area of nutrition. Therefore up-skilling in this area should be seen as a key part in our professional development.

Teaching and educating our patients about diet can assist in long term benefits to their oral health and their general wellbeing. A dietary assessment is the first step that we can undertake when addressing diet with our patients. This assessment will include discussing their current dietary behaviours such as frequency of snacking, dietary preferences, such as the intake of sugarsweetened beverages, as well as family or even cultural preferences. This information can then assist in identifying the factors that are contributing to a patient’s current or future risk of oral disease. Remember, dietary advice doesn’t always have to be a structured or clinical conversation, for example, asking your patient casually about their favourite food and drink may help to identify and create the opportunity to suggest a dietary change. You could lead on to “did you know that processed foods often have additives, sugar and preservatives that are not good for your teeth or your health”. By providing a nutritional assessment or dietary advice, we can empower our patients. It is important that they have an understanding of how their dietary behaviors can increase their risk of oral disease. Along with this advice, we need to offer our patients strategies to address any dietary concerns we are identifying. As with any behaviour change, gradual small changes can make a big difference. Having access to pre-prepared nutritional information can be helpful with this.

PREVENTATIVE Motivate your patients - with sugar smart ideas

References

Limiting and cutting down on sugar can be very challenging for many. Therefore, giving up or reducing the intake of one thing can be less daunting and more achievable than reducing all sugars in the diet.

Action for Healthy Kids. (2019). Rethink your drink. https:/www.actionforhealthykids.org/activity/rethinkyour-drink/

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Ask your patients about something they consume on a regular basis that is high in sugar and see if they are willing to give that up for 2 weeks.

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Cutting down sugary drinks can be a good start, and they can be replaced with water and healthy teas that taste good. Or another alternative is to try a healthy snack replacement.

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Remember knowledge is power. For many families and children understanding how much sugar is in certain foods and drinks can help them make more informed decisions.

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Children can do a sugar experiment at home with their drinks or food items. Such as the “rethink your drink” experiment found on the website.

Forshaw, R. (2014). Dental indicators of ancient dietary patterns: Dental analysis in archaeology. British Dental Journal, 216(9). Retrieved from https://www.nature.com/articles/sj.bdj.2014.353. pdf?proof=t. Healthline (2021). Mediterranean Diet 101: A Meal Plan and Beginner’s Guide. https://www.healthline. com/nutrition/mediterranean-diet-meal-plan Tanga, C., Viciano, J., Monza, F., D’Anastasio, R., Capasso, L. (2020). Dental palaeopathology seen through historical, archaeological and biological sources in ancient Herculaneum (79 AD, Italy). Medicina Historica, 2(4). Weaver, L. (2017). What am I supposed to eat?: Making sense of food confusion. Little Green Frog. World Health Organisation ( 2015) Sugars intake for adults and children. https://www.who.int/newsroom/fact-sheets/detail/sugars-and-dental-caries

https://www.actionforhealthykids.org/activity/rethinkyour-drink/ (Action for Healthy Kids, 2019). Additional information to supplement your oral health messages

About the author. Christine is an Oral Health Therapist who graduated from Auckland University of Technology. Prior to this she obtained qualifications in pharmacology and secondary teaching from the University of Auckland. She has a teaching/tutoring experience spanning more than ten years. Through this teaching experience combined with her diverse cultural background she has developed a passion for promoting diversity in clinical practice, overcoming communication barriers, and connecting with the community. As a member of the Colgate Advocates for Oral Health: Editorial Community, her contributions to the dental community aim to increase interest in sustainable interprofessional practice, provide an educational perspective on the delivery of existing oral health messages and working with vulnerable communities.

Provide a sample of healthy snack ideas- your practice may even like to develop a list. •

Talk about where to get affordable fruits and vegetables. Share your experience.

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Promote traditional methods of cooking.

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Share some of your favourite healthy recipes that are quick, easy and affordable.

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Talk about how their families - parents and grandparents prepared foods.

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Make referrals to other health professionals who can help provide more dietary interventions, including dietitians, nutritionists and GPs.

Colgate Professional website

CLICK HERE

CHRISTINE MURTHI Oral Health Therapist, Auckland

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PREVENTATIVE

WHY USE A PREPROCEDURAL RINSE?

Why Why Use Why Use A Preprocedural Use A Preprocedu A Prepro Why Use A Prep

THE BIOAEROSOLS GENERATED DURING DENTAL PROCEDURES The bioaerosols The bioaerosols generated The bioaerosols generated during generated dental duringPOSE procedures dental during procedures dental pose aprpp The bioaerosols generated during d A POTENTIAL RISK FOR the THEspread SPREAD OF INFECTIONS TO DENTAL (1,2) the of spread infections the of infections spread to dental of infections topersonnel dental personnel to and dental patients. personne and patie (1,2) the spread of infections to dental p PERSONNEL AND PATIENTS. What generates an aerosol?

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Oral Bacteria

Aerosols can stay suspended inup the air forprocedures up to four hours after dental procedures stay he air suspended for upair tofor four in the airfour for after to dental four hours after dental procedures nded in the uphours to hours after dental procedures and travel up to metres from the original source. travel up to three distances ofdistances up from to three theof original metres source. from the original source. tances ofcan up metres to three metres from thethree original source.

This can result in dentalbeing personnel being exposed, nn dental This can personnel result inbeing dental exposed, personnel exposed, result in dental being to threepersonnel metres from the originalexposed, source. This can result in dental personnel being exposed,(1,2) as infectedlinger aerosols can linger equipment past when protective equipment is removed. as infected aerosols can (1,2) (1,2) past past when protective is removed. aerosols past when can protective linger equipment when protective is removed. equipment is (1,2) removed. (1,2) an linger past when protective equipment is removed. Aerosols can stay suspended in the air for up to four hours after dental procedures and can travel distances of up

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and can travel distances of up to three metres from the original source. This can result in dental personnel being exposed, as infected aerosols can linger past when protective equipment is removed. (1,2)

PREVENTATIVE

How aerosols spread in the dental surgery

180cm short range exposure

300cm long range exposure

Patterns of bacterial splatter and aerosol can be used The most heavily contaminated areas are an operator’s to understand how a virus can spread during dental face (this may be possible even under the visor and procedures. Even when a high-volume suction is used, mask), arm nearest the patient, and the patient’s body. (3) there can be positive contamination. TheTHE assistant’s face SURGERY and arm are also often in HOW AEROSOLS SPREAD IN DENTAL the contamination zone. (3) The most heavily contaminated areas are an Patterns of bacterial splatter and aerosol can be operator’s face (this may be possible even under the used to understand how a virus can spread during When an effective preprocedural rinse is used, there is a mean reduction in the visor and mask), arm nearest the patient, and the dental procedures. Even when a high-volume suction (3) patient’s body. is used, there can be positive contamination. number of colony forming units of 64.8% when compared with control.(1) The assistant’s face and arm are also often in the contamination zone. (3)

(1) V. Costa Marui, M.L.S Souto, E.S. Rovai, G.A. Romito, L. Chambrone, C.M. Pannuti, (2019) Efficacy of preprocedural mouth rinses in the reduction of microorganisms in aerosol: A systematic review, The Journal of American Dental Association (JADA), Vol 150 (12) (2) S.K. Harrell, J. Molinari (2004). Cover Story, JADA, Vol 135. (3) N. Innes, I.G. Johnson, W. Al-Yaseen, R. Harris, R. Jones, S. KC, S. McGregor, M. Robertson, W.G. Wade, J.E. Gallagher (2020) A systematic review of droplet and aerosol generation in dentistry, Elsevier Public Health Emergency Collection

When an effective preprocedural rinse is used, there is a mean reduction in the number of colony forming units of 64.8% when compared with control.(1)

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COSMETIC & RESTORATIVE

TOOTH WHITENING: BASIC SCIENCE AND OTHER INTERESTING FACTS

What is the key ingredient in tooth whitening

The two main types of professional whitening are:

systems?

1) Take Home Whitening

The active chemical ingredient used in most

Home whitening has traditionally involved the patient

professional whitening systems is hydrogen peroxide, which is delivered as either Carbamide peroxide or Hydrogen peroxide. Hydrogen peroxide contains a single oxygen - oxygen bond, known as the peroxide bond - this is weak and unstable. When it breaks it decomposes into water and oxygen and releases free radicals. It is these free radicals that are reactive with other substances and have the ability to breakdown compounds that have colour or darker shades, called chromogens. These chromogens cause staining to our teeth, both intrinsic and extrinsic. The breakdown of these compounds means there is a reduction in the discolouration and hence a lighter looking tooth. 1 What type of delivery methods are there for

either during the day or at night as indicated for the given whitening product. There are also whitening systems such as Optic White Light Up Take Home, that uses a LED Device instead of custom made trays along with a unique 6% hydrogen peroxide serum, this system is indicated for 10 minutes a day for ten days to provide up to 7 shades whiter teeth. 2) In-Chair Whitening In-chair or in-office teeth whitening treatment is ideal of patients who want faster results. Traditional inchair systems use a higher-concentration of peroxide and therefore require a gingival barrier to reduce the

whitening treatments?

risk of gingival irritations or gingival burning. Many

There are different whitening methods available

activate the hydrogen peroxide. The Colgate Optic

and when deciding which option to go for, the advantages and disadvantages of each option should be explored and clearly explained to patients. Staying up to date on new technologies and innovations in whitening is also important for dental professionals so they know what options are available for patients.

wearing custom trays for the indicated length of time

systems will also use a light-releasing device to White Light Up In-Chair system uses a unique 10% hydrogen peroxide serum and an Indigo LED device to achieve up to 5.9 shade whiter in just a thirty minute treatment*.

COSMETIC & RESTORATIVE

Before and after

Potential side effects The most frequently occurring side effect during tooth whitening is sensitivity. This typically lasts between 1 and 4 days. It occurs because the hydrogen peroxide molecules are able to penetrate not only the enamel, but through the dentine and to reach the pulp. Another side effect, which can occur when hydrogen peroxide touches the gingiva is gingival irritation and, in some cases, burning.

Three consecutive 10 minute treatments, with the

This may also factor in what options you offer for

Optic White, Light Up In-Office Whitening kit.

some patients. This is why it is important to be aware of other options with formulations designed for minimal or no sensitivity including lower concentrations, new application methods and shorter

Reference

treatment times such as the Colgate Optic White

1. Carey C. M. (2014). Tooth whitening: what we now know.

Light Up range.

The journal of evidence-based dental practice, 14 Suppl, 70–76.

https://doi.org/10.1016/j.jebdp.2014.02.006

Dental professionals should screen all their patients for any aesthetic concerns about their smile and whether whitening can address these. If whitening is being offered in your practice, this should be displayed as an option within the practice, so patients are aware this is a treatment that you offer. From there, you and the patient can determine which type of whitening treatment would work best for them. *Refer to leaflet for full instructions

View Optic White online CLICK HERE

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PRACTICE GREEN

BEACONSFIELD DENTAL LEADING THE WAY IN SUSTAINABILITY

Beaconsfield Dental, a modern purpose-built dental clinic in the suburb of Berwick, has been at the forefront of sustainability, technology, and accessibility since it was built in 2013. The clinic's ultimate goal is to be self-sufficient in energy, water, and waste disposal, while inspiring others to follow its lead.

Despite the clinic's impressive sustainability measures, the journey to becoming energy self-sufficient is not without challenges.

Sustainability is a vital aspect of the clinic's operations as it helps reduce emissions, mitigates the impact on the environment, and saves costs. The clinic's environmental policy can be viewed on its website, where it lists various initiatives to limit environmental impact, including:

With no room for further solar panels, any excess power generated is wasted as the grid is not designed for this. To inspire others to follow its initiatives, the clinic shares its journey on social media.

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144 Solar panels generating over 260 megawatt hours in 9 1/2 years

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17,000 litre water tanks for garden watering and toilet flush

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Indigenous and native garden, including edibles

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14 compost bins outside Extensive recycling

By far, the most significant impact has been made by the solar panel array. The clinic's sustainability measures are not limited to the infrastructure but extend to the staff's behavior. Staff are encouraged to use the compost receptacle in the kitchen and the recycle bins in each treatment room. They also collect autoclave pouch paper for composting, while occasionally setting out to pick up rubbish from the surrounding area and the nearby Akoonah Park.

Beaconsfield Dental's sustainability measures communicate to its team and consultants that it cares for both the community and the environment. It is a motivating force and helps with job satisfaction. The clinic advises the dental community to start their sustainability journey in small steps and consolidate on those. Just start and do something. In conclusion, Beaconsfield Dental's sustainability journey is one of a kind, setting an example of sustainable practices that can inspire others to follow suit. Its initiatives go beyond infrastructure to include the staff's behaviour, making the sustainability journey a collective effort. The clinic's ultimate goal of becoming self-sufficient in energy, water, and waste disposal is ambitious but achievable, and its journey so far has been a remarkable success story.

COSMETIC & RESTORATIVE

PANAVIA™ SA CEMENT UNIVERSAL YOUR EVERYDAY, AWARD WINNING CEMENT

2023 DENTAL ADVISOR Top Product is an everyday cement that eliminates the need for a separate primer

PANAVIA™ SA Cement Universal adheres to virtually all substrates, including lithium disilicate, in a single procedure without the need for a separate primer or silane, and it also offers easy, gingivalfriendly removal of excess cement and requires no refrigeration. Therefore it is no wonder that this year DENTAL ADVISOR gave PANAVIA™ SA Cement Universal Top Product award in the category of Indirect Restoratives. What makes its strong and durable bond possible without the added step of applying a separate substrate is that PANAVIA™ SA Cement Universal combines two innovative technologies in a single product. The silane coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentine and enamel. The result is a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs for a wide variety of indications, including cementation of crowns/bridges, inlays/ onlays, posts, splints, and even adhesion bridges.

The significant benefits and quality of PANAVIA™ SA Cement Universal are reflected in the study findings and feedback of the 31 DENTAL ADVISOR clinical evaluators who used the cement in 516 applications and gave it an overall clinical rating of 96 percent. Their comments on its ease of use, handling characteristics, and aesthetics included: “Good flow and film thickness;” “Amazing viscosity, tack cureability, and very easy cleanup;” and “Great colour match, and I liked the universal ability to work with so many substrates.” The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardised or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify highquality new dental materials and determine which among them are best suited to fulfill their individual requirements. For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com

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COSMETIC & RESTORATIVE

FACE MEETS FUNCTION

Optimising functional and esthetic parameters in veneer cementation using panavia ™ veneer lc The use of both porcelain veneers to improve and restore the shape, shade and visual position of anterior teeth is a common technique in esthetic dentistry. The biomimetic aim in the restoration of teeth is not only the cosmetic domain, but also functional considerations. It is critical to note that the intact enamel shell of the palatal and facial walls with respect to anterior teeth are responsible for its innate flexural resistance. When dental structure has been violated by endodontic access, caries and/or trauma, every effort must be made to preserve the residual structure and strive to restore or exceed the baseline performance levels of a virgin tooth. 1. Background A 55 year old ASA II female with a medical history significant only for controlled hypertension presented to the practice for teeth whitening. It was foreseen that dental bleaching would not have an effect on the shade of a pre-existing porcelain veneer on tooth 1.2, and that this would need to be retreated following the procedure especially if the shade value changes were significant. The patient started with a baseline shade of VITA* 1M1:2M1; 50:50 ratio in the upper anterior region and 1M1 in the lower anterior region. Following a nightguard bleaching protocol with 10% carbamide peroxide worn overnight for 3-4 weeks, the patient succeeded in achieving a VITA* 0M3 shade in both upper and lower arches. As a result, there was a significant value discrepancy between the veneered tooth 1.2 and the adjacent teeth, and also increased chroma noted on the contralateral tooth 2.2 due to a facially-involved Class Ill composite restoration. This latter tooth also did not match the contralateral tooth in dimension and thus the decision was made to treat both lateral incisors with bonded lithium disilicate laminate veneers. The canine adjacent (2.3) featured localized mild to moderate cusp tip attrition, but the patient did not want to address this until following the currently-discussed veneers were placed. The goal of smile design at this stage is to ultimately establish bilateral harmony with the

view to place an additional indirect restoration restoring the facial volume and cusp tip deficiency of tooth 2.3 in the near future. 2. Procedure A digital smile design protocol was not required for the initial intention, which was individual treatment of the lateral incisors, as slight variation is permitted in this tooth type, being a personality and gender marker of the smile. Prior to anesthesia, the target shade was selected using retracted photos featuring both polarised and unpolarized selections. The photographs were prepared for digital shade calibration by taking reference views with an 18% neutral gray white balance card (Fig. 1). Fig.1

Reference photograph taken with a 18% neutral gray card.

The basic body shade was VITA* 0M2 with an ingot shade of BL2. The patient was anesthetized using 1.5 carpules of a 2% Lignocaine solution with 1:100,000 epinephrine before affixing a rubber dam in a split dam orientation. The veneer on tooth 1.2 was sectioned and removed from tooth 1.2 and a minimally-invasive veneer preparation completed on tooth 2.2 (Fig. 2). Partial replacement of the old composite resin restoration was completed on the mesioincisobuccopalatal aspect of tooth 12 with the intact segment maintained. Adhesion to old composite was achieved using both micro particle abrasion and a silane coupling agent (CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.).

COSMETIC & RESTORATIVE Margins were refined and retraction cords soaked in an aluminum chloride solution and packed. Preparation stump shades were recorded. Final impressions were taken using both light and heavy body polyvinylsiloxane in a metal tray. The patient was provisionalized and sent away with instructions to verify the shade at the laboratory at the bisque bake stage. The models prepared by the laboratory verify the minimally-invasive nature of the case.

Fig.2

Veneer preparation tooth 1.2, 2.2

On receipt of the case, the patient was anesthetized and the provisionals removed. The preparations were debrided and prepared for bonding by abrading the surfaces using a 27 micron aluminum oxide powder at 30-40 psi. The veneers were assessed using a clear glycerin try-in paste (PANAVIA™ V5 Try-in Paste Clear, Kuraray Noritake Dental Inc.). Retraction cords were packed and the intaglio surface of the restorations treated using a 5% hydrofluoric acid for 20 seconds prior to application of a 10-MDP-containing silane coupling agent (CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.) (Fig. 3). The tooth surface was etched using 33% orthophosphoric acid for 20 seconds and rinsed. A 10-MDP-containing primer was applied to the tooth (PANAVIA™ V5 Tooth Primer, Kuraray Noritake Dental Inc.) (Fig. 4) and air dried as per manufacturer’s instructions.

Fig.3

Fig.4

CLEARFIL™ CERAMIC PRIMER PLUS applied to intaglio surfaces of veneers.

PANAVIA™ V5 Tooth Primer application to etched tooth surfaces.

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COSMETIC & RESTORATIVE Veneer cement was loaded (PANAVIA™ Veneer LG Paste Clear, Kuraray Noritake Dental Inc.) (Fig. 5) and the veneer seated. The excess cement featured a non-slumpy character and maintained the veneer well in place during all margin verification exercises prior to a 1 second tack cure (Fig. 6).

Fig.5

Fig.6

PANAVIA™ Veneer LC Paste Clear shade loaded onto prepared intaglio surfaces of veneers.

PANAVIA™ Veneer LC Paste immediately after seating. Note the viscous, non-slumpy nature of the cement, which allows for ease of removal under both wet and gel-phase options.

The cement was rendered into a gel state, which facilitated “clump” or en masse removal of cement with minimal cleanup required (Fig. 7). The margins were coated using a clear glycerin gel prior to final curing to eliminate the oxygen inhibition layer (Fig. 8). Fig.7

Fig.8

Excess cement removal after tack curing for 1 second.

Final curing of veneers from both palatal and facial aspects simultaneously.

The margins were finished and polished to high shine and the occlusion of the restorations verified as conformative. The postoperative views show excellent esthetic marginal integration (Fig. 9).

Fig.9

Post-operative esthetic integration of veneers on 1.2 and 2.2.

COSMETIC & RESTORATIVE Fig.9 On polarised photograph reassessment, the restorations are well-integrated into the new smile esthetically and functionally (Fig. 10), now awaiting esthetic augmentation of tooth 2.3 to match the contralateral canine.

Final result with polarised photography on reassessment

3. Rationale for Material Selection

Indeed, PANAVIA™ V5 Tooth Primer is used solely in conjunction with Kuraray Noritake Dental Inc. PANAVIA™ V5 cement and PANAVIA™ Veneer LC which both allow the primer to act as a bond without the need to cure the layer prior to cementation of the indirect restoration due to its dual cure potential when married together.

Porcelain is often the chosen material for prosthetic dental veneers due to its innate stiffness in thin cross section, ability to modify and transmit light for optimal internal refraction and its bondability by way of adhesive protocols to composite resin. This trifecta allows for a maximal preservation of residual tooth structure whilst bolstering its physical function relative to flexural performance (1). The elastic modulus of a tooth can be restored to 96% of its control virgin value if the facial enamel is replaced with a bonded porcelain laminate veneer (2). The elastic modulus of lithium disilicate is 94 GPa whereas that of intact enamel is 84 GPa.

If a bonding agent would be preferred, CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.), a multi-modal adhesive that also contains the essential amide monomer and 10-MDP components created by Kuraray Noritake Dental Inc., can be used. Of note, CLEARFIL™ Universal Bond Quick features exceptional flexural strength due to the accentuated cross-linking during polymerization afforded by the amide monomers, on the order of 120 MPa by itself (4).

The elastic modulus of dentin has been found to range from 10-25 GPa, whereas that of the hybrid layer can vary widely, indeed from 7.5 GPa to 13.5 GPa in a study by Pongprueska et al (3). This low flexural resistance range reflects that of deep dentin and not that of superficial dentin, which does not reflect an ideal situation where a laminate veneer is bonded in as much enamel as possible, or in the worst case to superficial dentin. Maximal flexural strength of the hybrid layer is invaluable from a biomimetic standpoint. PANAVIA™ V5 Tooth Primer (Kuraray Noritake Dental Inc.) incorporates the use of the original 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) monomer, which elicits a pattern of stable calcium-phosphate nanolayering known as Superdentin, an acid-base resistant zone that is about 600x more insoluble than the monomer 4-MET, which is found in many other adhesives.

PANAVIA™ Veneer LC is a cement system that features cutting edge technology that provides excellent esthetics and adhesive stability of your indirect restorations, whilst allowing a stress free workflow. It is a cement system that is a game changer; one that allows you to restore confidence in the patient, strength in the tooth-restoration interface, and bolsters your clinical confidence in the delivery of biomimetic excellence.

References 1) Magne P, Douglas WH. Rationalization of esthetic restorative dentistry based on biomimetics. J Esthet Dent. 1999;11 (1):5-15. doi: 10.1111/j.1708-8240.1999.tb00371.x. PMID: 10337285. 2) Magne P, Douglas WH. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. lnt J Prosthodont. 1999 Mar-Apr;12(2):111-21. PMID: 10371912. 3) Pongprueksa P, Kuphasuk W, Senawongse P. The elastic moduli across various types of resin/dentin interfaces. Dent Mater. 2008 Aug;24(8):1102-6. doi: 10.1016/j. dental.2007.12.008. Epub 2008 Mar 4. PMID: 18304626. 4) Source: Kuraray Noritake Dental Inc. Samples (beam shape; 25 x 2 x 2 mm): The solvents of each material were removed by blowing mild air prior to the test.

DR CLARENCE TAM HBSc, DDS, FIADFE, AAACD Auckland, New Zealand 1 3 0 0

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TRANSFORMING DENTISTRY WITH GROUND-BREAKING TECHNOLOGIES:

DIRECT RESTORATION DIRECT RESTORATION PROCEDURES SIMPLIFIED PROCEDURES SIMPLIFIED

TRANSFORMING DENTISTRY WITH GROUND-BREAKING TECHNOLOGIES Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies conduct fundamental research and technology development inhouse. Is this difference relevant for someone who uses the resulting products in the dental practice or laboratory on a daily basis? It is – as companies developing everything from scratch usually have a deeper understanding of the products and their production procedures, which makes it easier for them to modify specific features, solve existing problems and respond to market needs. This article describes the impact of several basic technologies developed by Kuraray Noritake Dental Optimizing the bonding performance Some companies mainly make use of basic technologies Inc. on the workflow of creating direct composite restorations.

developed by others to improve their products and The Original MDP Monomer addressed the issue introduce new ones, while other companies conduct of limited long-term bonding performance of fundamental research and technology development DIRECT RESTORATIONS – FROM COMPLEX TO SIMPLE adhesive systems. MDP’s hydrophilic (phosphate) inhouse. Is this difference relevant for someone who uses group forms a particularly Adhesive restorative using high-performance dental adhesives and resin composites is currently one of thestrong and long-lasting the resulting productsdentistry in the dental practice or laboratory chemical bond with calcium most popular way of treating teeth with carious lesions. Nowadays, a single-bottle universal adhesive and one or two found in hydroxyapatite, on a daily basis? shades and opacities of universal composite are usually enough to create beautiful durable outcomes, provided the and main component of enamel and dentine. The that the right materials are selected. formed MDP-Ca salt provides the basis for a stable, It is – as companies developing everything from scratch

strong and durable hybrid layer. In combination with usually have a deeper understanding of the products and This, however, has not always been the case. For a long time, the techniques used createindirect thetoresin the restorations bonding have agent a tight seal of the their production procedures, which makes it easier for been quite complex: adhesives were technique-sensitive multi-bottle and multi-step systems with long application times. cavity after light-curing is the result. Down to the themComposite to modify specific features, solve existing problems filling materials, on the other hand, only produced lifelike outcomes when many different shades and opacities day, MDP is an essential component of any and respond to market needs. Thiseven article the were carried present were combined in the right way. And if the describes complex procedures out correctly, the risk of microleakage, adhesive product from Kuraray Noritake Dental Inc., impact of severaland basic technologies by Kuraray discolouration eventually secondary developed caries was comparatively high. Kuraray Noritake Dental Inc. focused on solving and it is the key component that made CLEARFIL™ Noritake Inc.early, on the workflow creating direct theseDental issues quite starting with the of utilization of the Original MDP Monomer developed in 1981. SE Bond become the Gold Standard self-etch composite restorations. adhesive system.

OPTIMIZING THE BONDING PERFORMANCE Direct Restorations – from complex to simple The Original MDP Monomer addressed the issue of limited long-term Adhesive restorative dentistry using highbonding performance of adhesive systems. MDP’s hydrophilic (phosphate) performance dental adhesives and resin composites group forms a particularly strong and long-lasting chemical bond with is currently one of the most popular way of treating calcium found in hydroxyapatite, the main component of enamel and teethdentin. with The carious a single-bottle formed lesions. MDP-Ca saltNowadays, provides the basis for a stable, strong and universal one or two shades durableadhesive hybrid layer.and In combination with the resin in and the bonding agent a opacities ofofuniversal composite enough tight seal the cavity after light-curingare is theusually result. Down to the present to create beautiful andcomponent durable ofoutcomes, provided day, MDP is an essential any adhesive product from Kuraray Dental Inc., and itare is theselected. key component that made CLEARFIL™ SE that Noritake the right materials Bond become the Gold Standard self-etch adhesive system.

This, however, has not always been the case. For a long time, the techniques used to create direct restorations have been quite complex: adhesives were technique-sensitive multi-bottle and multi-step systems with long application times. Composite filling materials, on the other hand, only produced lifelike outcomes when many different shades and opacities were combined in the right way. And even if the complex procedures were carried out correctly, 22702_1 Article Direct Restoration Procedures Simplified 02.indd 1 the risk of microleakage, discolouration and eventually secondary caries was comparatively high. Kuraray Noritake Dental Inc. focused on solving these issues quite early, starting with the utilization of the Original MDP Monomer developed in 1981.

The Original MDP monomer creates a strong chemical bond to Enamel, Dentine, Metal Alloy and Zirconia. The Original MDP monomer creates a strong chemical bond to Enamel, However, convinced that dental adhesives should Dentin, Metal Alloy and Zirconia.

provide for more than just a strong and long-lasting bond, Kuraray Noritake Dental Inc. started to focus on solving another issue: the risk of demineralization and cavitation caused by bacteria remaining in the cavity. Based on its experience in developing other adhesive monomers, Kuraray Noritake Dental Inc. invented the MDPB monomer that has an antibacterial cavity cleansing effect. Different from antibacterial agents that might impair the bond 19-08-22 16:28 strength of a subsequently applied adhesive, the MDPB monomer kills remaining bacteria without affecting the bonding performance. It is contained in the primer of the two-bottle self-etch adhesive CLEARFIL™ SE Protect and is immobilized by polymerization.

COSMETIC & RESTORATIVE

The bactericidal mechanism of MDPB is presumed to be similar to the well-know antibacterial agent CPC (Cetyl pyridinium chloride), which is in many toothpastes and mouth rinses.

While two-bottle self-etch adhesives has already simplified the adhesive procedure, singlebottle universal adhesives go the extra mile. It is a challenge to bring together ingredients distributed in multi-step systems in one bottle without compromising the stability of the product. Current technology now makes this possible. To seal the surface as soon as possible after application, the penetration of the monomers into the dental tissue must be fast and efficient. However, the penetration is usually slowed down by monomers that need time to penetrate the tooth structure – especially wet dentine – and sometimes even need to be rubbed into it. That is why Kuraray Noritake Dental Inc. focused on developing the Rapid Bond Technology. It consists of the Original MDP Monomer combined with newly developed hydrophilic cross-linking amide monomers and is integrated in CLEARFIL™ Universal Bond Quick. The hydrophilic amide monomers provide for a rapid, deep and complete penetration of the dentine and form upon curing a densely cross-linked polymer network responsible for a strong and durable bond. Hence, waiting and rubbing times are eliminated and a tight and long-lasting seal of the cavity is established after light-curing.

Prepared Dentin with smear layer. Due to its hydrophilicity we need a very hydrophilic bonding to be able to optimally penetrate the dentin.

Dentin bonded with Clearfil™ Universal Bond Quick. During curing CLEARFIL™ Universal Bond Quick creates a highly cross linked polymer network. As a result of this network, the bonding has a very low water absorption which gives a long lasting restoration

Due to their hydrophilicity (water-affinity), the amide monomers of the Rapid Bond Technology penetrate dentine very well. After light-curing, the bond exhibits low water sorption and therefore high aging-resistance.

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COSMETIC & RESTORATIVE Optimizing Direct Restoratives Combining multiple layers, shades and opacities: The use of highly complex layering techniques for the creation of lifelike composite restorations is luckily a thing of the past in many clinical situations. The reason: highly developed resin composites that blend seamlessly with the adjacent tooth structure. To provide for this favourable feature, Kuraray Noritake Dental Inc. has developed its proprietary Light Diffusion Technology (LDT). The technology is incorporated in special pre-polymerized fillers acting like millions of micro-prisms that transmit and refract light and colour from the surrounding tooth structure. Optimized in size, distribution and refractive index in relation to the matrix, the fillers offer unsurpassed natural blending. The whole CLEARFIL MAJESTY™ composite line-up contains this proprietary filler technology. Its latest product – CLEARFIL MAJESTY™ ES-2 Universal – in which Kuraray Noritake Dental Inc. makes use of next level LDT allows for a single-shade technique with simplified shade selection: it is available in two shades for the anterior and a single shade for the posterior region, but blends in so nicely that it covers virtually every shade of the VITA classical A1D4 shade guide.

Example of a single-shade restoration made of CLEARFIL MAJESTY™ ES-2 Universal.

Conclusion Adhesive monomers, filler technologies and silane technology providing for a solid combination of fillers, clusters and resin matrix: Kuraray Noritake Dental Inc. clearly is a trusted expert in the field of adhesive restorations. The proprietary technologies developed during the past decades have definitely contributed to a better (long-term) performance of direct restorations, and to reliable and aesthetic outcomes more easily achieved.

FE1060 5.0 kV 5μm A+B 2012/12/04 24.000μm x 18.000μm

Refracting and transmitting light in the right way for a great optical integration: light diffusion fillers of CLEARFIL MAJESTY™ ES-2 from Kuraray Noritake Dental Inc. As a great optical appearance is not only dependent on optical integration and undetectable restoration margins, Kuraray Noritake Dental Inc. also developed fillers that provide for the rest – a natural surface gloss and longterm polish retention. The solution integrated in CLEARFIL MAJESTY™ ES Flow with its three levels of flowability is called Submicron Filler Technology, which consists of glossy submicron-sized fillers. These fillers are so small that light reflections show a natural effect even after wear. Kuraray Noritake Dental Inc.’s exceptional silane technology is used to join millions of those submicron fillers and keep them together over time. It allows for high filler loads in the low-viscosity composites and limits water uptake that would otherwise lead to degradation of the cured composite. The perfect balance between the glossy submicron fillers, light diffusion fillers, resin matrix and proprietary silane technology is responsible for a balanced combination of mechanical and optical properties.

*Clearfil SE PROTECT not available for sale in Australia

COSMETIC & RESTORATIVE

CEMENTATION OF INDIRECT RESTORATIONS TRANSFORMING DENTISTRY WITH GROUND-BREAKING TECHNOLOGIES

Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies conduct fundamental research and technology development inhouse. Is this difference relevant for someone who uses the resulting products in the dental practice or laboratory on a daily basis? It is – as companies with a deep understanding of the underlying components, chemistry and technologies are able to solve existing problems and respond to market needs flexibly and quickly. This article describes the impact of several basic technologies developed by Kuraray Noritake Dental Inc. on the cementing of indirect restorations. The fact that it is still part of every adhesive and adhesive cementation system from Kuraray Noritake Dental Inc., and meanwhile also used by other manufacturers to optimize the bond strength and bond durability of their products, stresses the ingenuity of the invention. Compared to MDP synthesized elsewhere, the Original MDP Monomer from Kuraray Noritake Dental Inc. stands out due to an unmatched level of purity. Independent Studies show that this level of purity has a positive effect on its bonding behaviour1. By offering stability in a moist environment, the MDP Monomer has contributed to a more consistent performance of the products containing it.

Adhesive cementation then and now The possibility of milling dental restorations from different kinds of ceramics has opened up new opportunities in prosthodontics: highly aesthetic restorations can be produced and placed. What is often undervalued in this context is the role of adhesive cementation systems, which not only support the aesthetic appearance of the translucent, tooth-coloured restorations, but also pave the way for less invasive preparation and restoration designs. Early systems that provided for chemical adhesion between teeth and indirect restorations unfortunately offered a compromised long-term behaviour and high technique-sensitivity, while the application procedure was extremely complex. Technology development at Kuraray Noritake Dental Inc. made significant contributions to an improved long-term bonding performance of the systems and a simplified handling.

MICRO-TENSILE BOND STRENGTH TO DENTINE

Optimising the long-term bonding performance In order to achieve long-term bonding of early cementation systems to tooth structure (especially dentine), Kuraray, a parent company of Kuraray Noritake Dental Inc., decided to focus on the development of a more powerful adhesive monomer in the 1970s. As a first step on its road to excellence, it introduced the phosphate monomer Phenyl-P in 1976. Five years later, continued efforts in improving and refining its molecular structure led to the introduction of the popular MDP Monomer that is capable of establishing a particularly strong and long-lasting bond to enamel, dentine, metal and zirconia.

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Different MDP Monomers offer different levels of purity and a different bonding performance. Three experimental self-etch primers were prepared consisting of 15 wt.% 10-MDP provided by different sources: KN (Kuraray Noritake Dental), PCM (Germany) or DMI (Designer molecules Inc., USA). Data courtesy of Dr. Kumiko Yoshihara.

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COSMETIC & RESTORATIVE

For adhesive resin cement systems to deliver a strong bond with an outstanding marginal seal, however, simply containing an adhesive monomer is not enough. Effective polymerization of this monomer is necessary as well – and not always that easily accomplished. In order to provide for an effective light-cure and dark-cure performance of PANAVIA™ V5, Kuraray Noritake Dental Inc. developed the Touch-Cure Technology. The key part of this technology is a newly developed, highly-active polymerisation accelerator in PANAVIA™ V5 Tooth Primer that is able to coexist with the acidic MDP Monomer and promotes polymerisation starting from the interface between the tooth and the cement as soon as PANAVIA™ V5 Paste is applied to the already primed tooth surface. In PANAVIA™ Veneer LC – a light-curing resin cement system that works with the same primers – the polymerisation accelerator in PANAVIA™ V5 Tooth Primer shows the same mechanism of action. It contributes to the polymerization of the adhesive interface, while PANAVIA™ Veneer LC Paste offers excellent ambient light stability and is polymerized by light curing. For example, this phenomenon was evaluated for PANAVIA™ F2.0, the predecessor of PANAVIA™ V5. The result of the study: PANAVIA™ F2.0 showed much better marginal sealing properties than other cement systems evaluated2.

This documented secure sealing of the interface leads to a lower incidence of marginal leakage, to a very high polymerisation ratio even in the self-cure mode (without light curing or wherever the light is blocked by the restorative material) and hence to a particularly strong bond. An additional benefit arising from the incorporation of the polymerisation accelerator is its function as a strong reductant. It neutralizes sodium hypochlorite, which is commonly used as an irrigation solution during endodontic treatment, and thus eliminates its negative effect on the bond strength of the subsequently applied cement paste. A highly active polymerisation accelerator in PANAVIA™ V5 Tooth Primer promotes effective polymerisation of the cement at the adhesive interface.

COSMETIC & RESTORATIVE Simplifying glass-ceramic cementation

Conclusion

Fewer bottles, fewer steps and streamlined cementation procedures: that is why self-adhesive resin cements have been developed and introduced in the early 2000s.

Technologies developed by Kuraray Noritake Dental Inc. have strongly contributed to an improved bonding performance of adhesive cementation systems and a truly universal use of self-adhesive resin cements.

Most of these products, however, have a limited indication range. They work well on zirconia, metal, enamel and dentine, but are either not recommended or need an extra silane primer for glass-ceramic bonding. The MDP-containing PANAVIA™ SA Cement Universal is different due to another proprietary technology from Kuraray Noritake Dental Inc.: the LCSi Monomer, a Long Carbon-chain Silane coupling agent. This monomer forms a strong chemical bond with resin composite, porcelain and silica-type ceramics (like lithium disilicate), so that the need for a separate silane component (a primer or adhesive) is eliminated.

As a consequence, the company offers a streamlined portfolio of high-performance resin cements for every user, for the typical clinical situations. Fewer components and fewer steps are necessary and procedures simplified – for fewer errors and aesthetic restorations that last. Apart from the technology-related benefits, the products mentioned offer many additional beneficial features. A detailed description is found online at kuraraynoritake.eu.

By leveraging the benefits of this technology, PANAVIA™ SA Cement Universal clearly sets itself apart from other self-adhesive resin cements as a true single-component cementation system even for restorations made of glass ceramics.

References

If desired, the product’s bond strength to tooth structure can be increased by use of the popular universal adhesive CLEARFIL™ Universal Bond Quick featuring Rapid Bond Technology. This technology has been developed by Kuraray Noritake Dental Inc. to solve problems related to the slow penetration of tooth structure, especially wet dentine, typical for universal adhesives.

Functional monomer impurity affects adhesive performance.; Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Dent Mater. 2015 Dec;31(12):1493-501.

Touch-Cure Polymerization at the Composite Cement-Dentin Interface.; Yoshihara K, Nagaoka N, Benino Y, Nakamura A, Hara T, Maruo Y, Yoshida Y, Van Meerbeek B.J Dent Res. 2021 Aug;100(9):935-94.

In order to provide proper penetration, these adhesives need to be actively rubbed into the tooth structure for a long time or users have to wait for some time before lightcuring the layer. Consisting of the Original MDP monomer combined with hydrophilic amide monomers, the proprietary Rapid Bond Technology provides for a high affinity to water leading to a rapid and deep penetration of wet dentine. As a consequence, application times are shortened and handling is simplified without negatively affecting the bonding performance.

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COSMETIC & RESTORATIVE

THE PERFECT PARTNERS FOR STRONG, DURABLE RESTORATIONS INITIAL LISI BLOCK + G-CEM ONE

TOO MUCH TO RESTORE, TOO LITTLE TIME? GAIN TIME WITH OUR PROSTHETIC SOLUTIONS 1. Mill with Initial LiSi Block Gain time: no firing needed Thin, accurate* margins 2. Optional: enhanced adhesion with G-CEM ONE Adhesive Enhancing Primer or G-Premio BOND 3. Lute with G-CEM ONE Sets in 4 minutes only Universal indications

Initial LiSi Block Fully crystallised lithium disilicate CAD/CAM Block

G-Premio BOND One-component light-cured universal adhesive

G-CEM ONE AEP Adhesive enhancing primer

G-GCEM ONE Universal dual-cured composite resin cement

SOLVED WITH GC 1. Hoshino T, Matsudate Y, Sasaki K (2020). Wear resistance of CAD/CAM glass ceramic blocks. J Dent Res 99 (Spec Iss A):1823. 2. Kato K et al. (2020). Edge Chipping Resistance of Glass Ceramic Block for CAD/CAM. J Dent Res 99 (Spec Iss A):0083. 3. Kariya S, Azuma T, Fusejima F (2020). Wear Resistance of Novel Machinable Glass Ceramics. J Dent Res 99 (Spec Iss B):1 4. Hoshino T, Matsudate Y, Sasaki K (2019). Chemical durability of CAD/CAM glass-ceramic blocks. J Dent Res 98 (Spec Iss A):0100. 5. Kojima K et al. (2019). Wear properties of lithium silicate glass ceramic block for CAD/CAM. J Dent Res 98 (Spec Iss A): 1259. 6. Akiyama S et al. (2019). Edge-Stability of the Novel Lithium Disilicate Glass-Ceramic Block for CAD/CAM. J Dent Res 98 (Spec Iss A): 0097. *Source: GC R&D, Japan Data on file.

Pictures: courtesy of Dr. J. Tapia Guadix, Spain (top left), Prof. R. Sorrentino, Italy (bottom left) and Dr. C. Mazzitelli, Italy (right

Natural beauty restored in one appointment Initial LiSi Block is a fully crystallized lithium disilicate block that delivers optimal physical properties without firing. This unique block features GC’s proprietary HDM (High Density Micronization) technology for CAD/CAM dentistry to deliver high wear resistance, smooth margins and aesthetic final results. This makes it an ideal, time saving solution for single visit chairside treatments. 1-6

COSMETIC & RESTORATIVE

EQUIA FORTE® HT NEXT GENERATION OF BULK FILL GLASS HYBRID RESTORATIVE SYSTEM

EQUIA Forte® HT is a versatile and durable restorative solution, ideal for patients of all ages, including paediatric, geriatric and high-risk caries patients. With enhanced mechanical properties, sound marginal seal and excellent handling, EQUIA Forte® HT with eco-friendly capsules is a strong, permanent solution for all generations. The material can be placed in bulk and is easy to pack and contour— taking only 3’25” to complete your restoration.1

Images courtesy of Dr. Victor Cedillo Felix, San Diego, CA.

Taking glass hybrid to the next level The strength and handling are further improved in EQUIA Forte® HT by developing an intelligent control of distribution and interaction of glass particles. Also, EQUIA Forte® Coat is now available in an ergonomic flip-top bottle that minimises waste. The result? A strong restorative with prolonged working time and superb handling that is excellent for bulk-fill placement, even in load-bearing Class II restorations.2

25%

LESS PLASTIC

Fast and easy placement EQUIA Forte HT has been designed to make your daily restorative work as easy and efficient as possible. Since rubber dam placement and adhesive application are not required, the restoration can be finished quickly. It is a material that is easy to use, yet the longevity is not compromised.1

By reducing the number of components, this capsule uses about 25% less plastic than typical products. It is used in our flagship product EQUIA Forte HT and other products.

GC eco-friendly capsules EQUIA Forte® HT capsule packaging has less total mass than the other products tested while wasting the least amount of packaging per gram of usable restorative, making it the most efficient packaging design.3

1. Assuming average procedure times following the instructions for use. 2. Compressive and flexural strength data Source: GC R&D, Japan, 2018. Data on file ISO9917-1: 2007. Three-point bending test (ISO10477:2004). Source: University of Siena, Italy. Publication in preparation. 3. Cowen M., Powers J.M. Capsule Waste Evaluation for Restorative Materials. Biomaterials Research Report. Dental Advisor. 2023;164.

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CLASS IV RESTORATION WITH DIRECT COMPOSITE RESIN

A case study utilizing the layering-stratification technique with the G-ænial A’CHORD composite system The concept of layering or stratification of direct composite restorations utilises the combination of optical properties from the different resin layers with the aim of emulating the natural colour, characteristics and translucency of the natural dentition. Progressive improvements in composite resin technologies have led to the simplification of this treatment procedure that is commonly perceived as complex. However, difficulties exist in mimicking the remaining tooth structure when restoring teeth in the anterior segment of the dentition because of the variety of shades, chroma, and translucency levels of many current composite resin systems. The G-ænial A’CHORD represents the evolution of the highly successful G-ænial system that has been utilised in dental practices throughout the world for the past 10 years. Compared to its predecessor, the G-ænial A’CHORD system provides an upgrade from the original G-ænial system in the following aspects:

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Beautiful and harmonious under any light with a natural fluorescence. Optimal handling properties allowing for the material to be easily sculpted with conventional composite manipulation instruments or brushed with restorative brushes The Full-Coverage Silane Coating (FSC) technology that covers the nano-fillers with silane coupling agent leads to high polish and gloss with only a few steps. The incorporation of additional opaque and enamel shades allows an infinite range of opacity and value possibilities. Simplification with 5 CORE shades which covers all 16 Vita shades.

Case Report The following case study demonstrates the use of the G-ænial A’CHORD. (GC Europe) direct composite system in the restoration of a complex class IV in a 22-year old female patient. The patient presented to the practice relaying her dissatisfaction of an existing restoration on her upper left central incisor (FDI tooth 21). She requested its replacement with a new restoration that was conservative and “invisible” when she smiled or engaged in normal conversation. She also relayed that the existing class IV restoration had been done 4 times by her previous dentist without an outcome or result that was satisfactory to her. Clinical examination revealed a high smile-line with a symmetrical and aesthetic gingival architecture. The existing composite restoration on the tooth 21, while clinically acceptable, did not integrate with the shade of the tooth and to the other teeth in her dentition. The discolouration and minor ledging on the distolabial aspect of the existing restoration also indicated the likelihood of marginal leakage in the region. The pre-operative colour assessment showed that the upper left central incisor (21) was slightly more chromatic than the adjacent upper right central incisor (11). The upper left central incisor (21) also exhibited a very slight labial displacement in its alignment compared to the adjacent right central incisor (11). The patient’s health history was unremarkable. Radiographic and periodontal examination showed that the tooth 21 demonstrated no pathology or issues requiring intervention prior to the commencement of the restoration. The 21 exhibited a normal response when the vitality was thermally tested.

COSMETIC & RESTORATIVE

The treatment options were discussed with the patient and the advantages and disadvantages of each of the options were carefully identified. The options presented were: 1) A single reductive ceramic veneer on tooth 21. 2) A full surface composite veneer on tooth 21. The patient was advised that due to the slight labial displacement of tooth 21, a very small labial reduction would be required to allow the space to mask the chromatic dentine. 3) A conservative complex class IV on the tooth 21 to be completed additively to minimise any preparation and reduction of the natural tooth structure. She preferred the conservative approach to her treatment involving an additive protocol (option 3).

She relayed that she would be happy with a harmonious composite restoration on tooth 21 and did not feel that the slightly chromatic upper left central(21) would be an aesthetic concern for her. From the clinician’s perspective, final plan and goal of the treatment was to restore the tooth 21 with a durable and long-lasting conservative direct composite restoration with a final result that is biomimetic with optimal aesthetic and morphological integration with her existing natural dentition. Step By Step Prior to the commencement of the restorative process, diagnostic images and the selection of the estimated shade was completed. Diagnostic impressions were also taken to allow the fabrication of silicone palatal stent or matrix that would facilitate the three-dimensional blueprint for the layering of the composite increments.

b) Figure 1: Pre-Operative unretracted view illustrating the unaesthetic and failing direct composite restoration on the upper left central incisor (tooth 21).

Figure 3: The working field was isolated with the use of the rubber dam. The existing restoration and caries was removed and a 2 mm bevel prepared on the labial margin of the preparation to facilitate the aesthetic and functional integration of the restoration to the remaining natural tooth structure.

Figure 4: The bevel was prepared and finished with a tapered diamond bur (Komet 6862.314.012 & 8862.314.012). All the transition angles of the cavity were rounded with an oval or egg-shaped polishing diamond bur (Komet 8379.314.023). The burs form part of the “Dr Anthony Mak Custom C&B Selection” Kit from Komet Dental.

Figure 6: The cavity was lightly air abraded with a 29-micron aluminium oxide powder AquaCare (Velopex) prior to the adhesive procedure and Teflon (PTFE) tape was utilised to prevent the inadvertent bonding to the adjacent teeth.

Figure 7: The adhesive procedure commenced with the with the cavity selectively etched with 37% phosphoric acid gel Ultra-Etch (Ultradent). The etching gel was rinsed away and the adhesive protocol was completed by the application of a universal bonding agent, G-Premio BOND (GC Europe). The universal bonding agent was then air dried for 5 seconds with maximum air pressure and light-cured for 10 seconds according to the manufacturer’s instructions.

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Figure 2: Pre-Operative Retracted a) with regular flash b) with Polarized filter.

Figure 5: The palatal stent was trimmed and tried-in to verify the fit of the silicone matrix and to ensure the absence of any interferences to its seating from the rubber dam and clamps.

Figure 8: Following the adhesive protocol, a thin layer of semi-translucent enamel, G-ænial A’CHORD shade JE (GC), was used to create the palatal shell.

COSMETIC & RESTORATIVE

Figure 9: The interproximal wall was then completed utilising the same semi-translucent enamel shade, G-ænial A’CHORD shade JE (GC). The interproximal wall was formed with the use of a plastic myeloid strip and pull through technique to help developing an anatomical contour.

Figure 10: The dentine layer was then completed by the application of an opaque shade, G-ænial A’CHORD shade AO2 (GC). This increment was shaped to emulate the extensions of natural dentine core morphology and was extended just slightly short the prepared bevel. The dentine or opaque shade provides the correct opacity to the final restoration.

Figure 11: A chromatic body shade, G-ænial A’CHORD shade A2 (GC) was then applied and extended beyond the bevel to mask the transition line. Internal anatomy (i.e. mamelons) in the incisal third was also sculped and formed in this increment of composite resin.

Figure 12: White tints, Essentia White Modifier (WM) (GC Europe) was utilised to accentuate the mamelons and to replicate the similar characteristics and features present in the adjacent right central incisor (tooth 11). Comparisons to the polarised diagnostic images taken prior to commencement of the restoration provided a reference for the incorporation of these internal features.

Figure 13: A final translucent shade of G-ænial A’CHORD shade JE (GC Europe) was then layered to bring the anatomy to full contour and to achieve a natural optical blending effect.

Figure 15: The restoration was then polished and finished to incorporate the primary, secondary and tertiary anatomy with the aim to produce a life-like restoration that mirrored the adjacent right central incisor (tooth 11).

b) Figure 14 a, b: Glycerine gel was then applied over the buccal surface of the restoration and light-cured to maximise the polymerisation of the layered direct composite restoration due to the absence of the oxygen- inhibition layer.

Figure 16: The polishing and finishing protocol employed the use of abrasive discs (Soflex; 3M-ESPE), polishing diamond burs (Komet), followed a graded sequence of silicone polishers and finishers (Astropol; Ivoclar-Vivadent). The restoration was then completed using a Diapolisher paste (GC) on a felt-buff (Flexi-Buff; Cosmedent Inc) to recreate the gloss of natural enamel.

b) Figure 17: Immediate post-operative (Unretracted). The finished and polished G-ænial A’CHORD (GC) restoration demonstrates the morphological and optical aesthetic integration of the completed restoration to the existing natural dentition.

Figure 18: Immediate post-operative (Retracted) a) regular flash b) polarised filter

COSMETIC & RESTORATIVE

Figure 19: 2-week review demonstrating the complete optical and functional G-ænial A’CHORD restoration on the tooth 21.

Figure 20: 2-week review demonstrating the complete optical and functional G-ænial A’CHORD on the tooth 21.

Conclusion This is due to the intrinsic anatomy of the natural tooth where the emulation of the optical and morphological properties cannot be achieved by a single mass of restorative material.

While developments in single shaded universal composite systems for the anterior dentition continue to improve and advance layering techniques for the placement of a truly aesthetic anterior direct composite restoration will always be necessary in the contemporary aesthetic dental practice.

The G-ænial A’CHORD (GC) composite system has a simplified approach to the shading/layering process while providing a final result that is truly biomimetic, aesthetic and long-lasting.

Class IV restoration

VITA® Classic

A3.5

Opaque

AO1

AO2

AO3

AO1

AO2

AO3

AO2

AO3

AO1

AO2

AO3

CORE

A3.5

Enamel

Dr Anthony Mak graduated with multiple awards from the University of Sydney in 2002 and completed his Post Graduate Diploma in Clinical Dentistry (Oral Implants). Anthony is the author of two compelling compendiums and has published numerous articles for known dental bodies and associations. Anthony’s interest lies in dental technologies, advances in materials and techniques specially CAD/CAM digital dentistry. Anthony runs two practices in metropolitan Sydney, focusing on quality modern comprehensive care, including aesthetic and implant dentistry and is a key opinion leader for several global dental companies. He also sits on the Restorative Advisory Board for GC Europe, the Executive planning committee for the Graduate Diploma in Implant Dentistry (Sydney University), an executive committee member for the Dental Alumni of the University of Sydney, and is the team leader in Australia for the BioEmulation Group.

Multi-layering technique correspondance

G-ænial A'CHORD ®

Enamel

Opaque

CORE

Enamel

A’CHORD Shade Guide CORE Shades

VITA® Classic

A1 B1 D2

CORE

Enamel

A3.5

A2 B2 C1 D3

A3 B3 C2 C3 D4

A3.5 B4 C4

One-shade technique correspondance

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® G-ænial A'CHORD CLICK HERE Standard Shades

Opaque Shades BOW

AO1

AO2

AO3

Dr Andrew Chio completed his dental degree from the University of Melbourne in 1995 where he graduated at the top of his year and was awarded with several awards for clinical achievement. While practicing dentistry predominantly in a private setting, Dr Chio has also previously worked in the public system, participated in clinical programs with the Royal Flying Doctors and worked in a rural hospital in Nepal, giving him a wide perspective of the demands and challenges of general dentistry. Dr Chio maintains an active role in dental education through his involvement with university undergraduate programs (La Trobe University) and his involvement in various Continuing Education Programs. He has published articles in restorative dentistry in various dental publications as well as in peerreviewed journals.

with direct composite resin: A case study utilising the layering-stratification technique with the G-ænial A’CHORD composite system By Dr. Anthony Mak and Dr. Andrew Chio, Australia

The concept of layering or stratification of direct composite restorations utilises the combination of optical properties from the different resin layers with the aim of emulating the natural colour, characteristics and translucency of the natural dentition. Progressive improvements in composite resin technologies have led to the simplification of this treatment procedure that is commonly perceived as complex. However, difficulties exist in mimicking the remaining tooth structure when restoring teeth in the anterior segment of the dentition because of the variety of shades, chroma, and translucency levels of many current composite resin systems. The G-ænial A’CHORD represents the evolution of the highly successful G-ænial system that has been utilised in dental practices throughout the world for the past 10 years. Compared to its predecessor, the G-ænial A’CHORD system provides an upgrade from the original G-ænial system in the

following aspects: • Beautiful and harmonious under any light with a natural fluorescence. • Optimal handling properties allowing for the material to be easily sculpted with conventional composite manipulation instruments or brushed with restorative brushes. GC get connected

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DR ANTHONY MAK

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CREATION OF A NEW SMILE BY AHMED SAAD

An indirect smile makeover requires thorough treatment planning, the right technique, and the selection of the correct materials, including temporization, impression and cement. A 26-year old female patient came to our practice complaining about shape and shade of her teeth and seeking for an aesthetic improvement. As an indirect approach was chosen based on the clinical findings, an impression was taken with an A-silicone (DMG A-silicon Honigum) to fabricate a provisional restoration in order to let the soft tissues heal (after gingivectomy).

Fig.1 Initial situation of the patient with the un-accepted shape and shade of the teeth and multiple carious lesions.

Fig.2 Initial intraoral situation.

Fig.3 Close – up view of the teeth, the far-from-ideal width to length proportion was the main reason for crown lengthening.

Fig.4 A gingivectomy and crown lengthening without bone reduction (only soft tissue) was enough to increase the length of the teeth.

Fig.5 A 0.5-mm depth-cutting bur was used during the initial preparation by following the curvature of the labial surface.

Fig.6 A pencil was used to mark the depth created by the guide groove bur.

COSMETIC & RESTORATIVE

Fig.7 A coarse diamond bur was then used across the whole facial surface and after the thickness and the depth reduction, the dentist should focus on the preparation design and follow some basic rules: Respect buccal convexit. Cervical margin located 0.5 with the level of the gum.

Fig.8 Due the low amount of enamel on the labial surface, the proximal spaces were opened to expose more enamel. A Soflex disc was used at low speed to round the sharp angles to avoid stress concentration at these areas.

Fig.9 Final preparation for veneers, and its finish line was then evaluated from the incisal before final impression.

Fig.10 The impression was taken with a single step technique using DMG Honigum Putty Soft Fast and Honigum Pro Light Fast.

Fig.11 Mixing the material with the longitudinal method to get perfect mixing.

Fig.12 The light body material is very flowable and able to fill all the space created by the second retraction cord, with the double mix technique it is also necessary to inject the material (light body) around the prepared teeth.

Fig.13 O-Bite for bite registration is a superior new bite registration material that provides you with exceptional accuracy, predictability and speed, specifically developed to yield more stable and precise bite registrations.

Fig.14 Long working time, short setting time and highest final hardness of the bite is very important for both dentist and lab.

Fig.15 The impression was cut with a surgical blade to fabricate an upper arch index.

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COSMETIC & RESTORATIVE

Fig.16 The first impression was then filled with a selfcuring resin material (DMG Luxatemp Star) in order to create a temporary restoration for the prepared tooth. DMG Luxatemp Star A2 resin was applied inside the silicone index. When doing so, the mixing tip should be not removed from the silicone index until all the teeth are filled, in order to prevent internal voids.

Fig.17 After placing the index in the mouth, we should wait for the gel phase before removing the excess material. Then keep the index in the mouth for two more minutes before removing it for polishing procedures.

Fig.18 After removing the index from the patient’s mouth, some finishing and polishing is required to remove the excess and sharp edges especially from the gingival embrasure area to create space for the papilla to heal and to fill the embrasure.

Fig.19 Two weeks later, with the provisional restorations.

Fig.20 Lithium disilicate (e-max) ceramic veneers were fabricated by the dental lab.

Fig.21 Vitique is a premium cementing system for complicated veneer work. The light-curing, composite-based cements are available in a wide range of shades. Perfectly matched try-in pastes for each shade allow a reliable preview of the final result.

Fig.22 Before cementation, the veneers fit was checked inside the patient’s mouth. An aesthetic resin cement (DMG Vitique White) was be used for cementation, with the air of an Optragate latex-free lip and cheek retractor.

Fig.23 Try-in stage before the final cementation, the gingiva looks very white due to local anesthesia and the effect of the retraction cord. The purpose of the retraction cord (size 1 cord mostly used) at this stage is to achieve enough vertical displacement of the gum to expose the finish line, in order to evaluate the relationship between the finish line and the margin of veneers, and to be able to safely remove all composite excess.

Fig.24 Evaluate the integration between margin and finish line, note the blue retraction cord under the gingiva for vertical displacement. It’s important to remove the cord as quickly as possible after finishing the cementation procedure to avoid the permanent damage of junctional epithelium.

COSMETIC & RESTORATIVE

Fig.25 Final intraoral situation of the patient.

Fig.26 Side view of fit and texture.

Fig.28 Final intraoral situation.

Fig.29 Final smile.

Fig.27 Before and after.

Conclusions Bis-acryl resin materials such as DMG Luxatemp Star, are an aesthetic, fast and easy solution to fabricate a temporary restorations in the dental office. The choice of materials is very important, In this case was used the resin cement (DMG Vitique) that available in wide range of shades to suit every case and his special veneers tip allows for easy and controlled application of the cement in addition to a try-in paste with a matching color is available and can be used to check the color match in difficult cases before the veneers are finally cemented. BIBLIOGRAPHY 1 .Galip G. The science and art of Porcelain Laminate Veneers, London, Quintessence, 2003. 2. Koubi S. Laminate veneers. 2020 Quintessence.

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DR AHMED SAAD

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COSMETIC & RESTORATIVE

EFFECTIVE SOLUTION FOR A DEFECTIVE AMALGAM RESTORATION

Patient presentation Dental amalgam has been used for the restoration of Class I and Class II cavities for many years. However, concerns about its lack of aesthetics, health and environmental issues have led to an increase in demand for tooth coloured restorations in the posterior region. Resin composite offers the opportunity for clinicians to provide both aesthetic and conservative restorations that are sealed to the underlying tooth. This case demonstrates the replacement of a defective amalgam restoration using BRILLIANT EverGlow (COLTENE), which is a universal submicron hybrid composite that can be used for both anterior and posterior restorations.

The inclusion of selective translucent and opaque shades allows for creative colour correction or incisal effects, which are particularly useful for anterior restorations. Treatment protocol

Patient presentation

Following anaesthesia, the upper left quadrant was isolated using a rubber dam. Meticulous isolation is required to facilitate contaminant free bonding and reduce the likelihood of microleakage.

In this case, a 44-year-old male presented with persistent temperature sensitivity localised to the upper left first molar (Fig. 1). The patient had previously expressed interest in replacing the existing amalgam filling that was over 20 years old for a new tooth coloured alternative.

Once achieved it can make restoration placement less stressful by producing a very clean and tidy working field. Removal of the restoration revealed no underlying cracks and areas of secondary caries were fully removed until hard dentine was reached.

Examination and diagnosis

A sectional matrix was used to best rebuild the proximal wall (Fig. 2). Enamel was selectively etched using 37.5 % phosphoric acid (Etchant Gel S, COLTENE) then fully rinsed and dried.

Following investigation the tooth was hypersensitive to sensibility testing particularly around the occlusal margins of the restoration. Fracture testing proved to be negative and no irreversible pulp problems were detected. Radiographs revealed some areas of cervical burnout but no significant bone loss or strong evidence of caries. A provisional diagnosis was made as marginal microleakage from the existing amalgam restoration +/underlying secondary caries. Treatment plan Due to the symptoms it was agreed to remove the previous restoration to explore for cracks and remove any caries. A definitive direct composite replacement was planned to restore the tooth to full functionality and meet the

patient’s aesthetic expectations. Prior to isolation, a shade selection (A2/B2) was made using the combined kit shade guide. It uses a simplified shade system with seven body shade groupings making single shade restorations very simplistic, which is ideal for posterior restorations.

A universal one step bonding resin (ONE COAT 7 UNIVERSAL, COLTENE) was applied to both enamel and dentine using a microbrush in a scrubbing motion for two periods of 20 seconds followed by light air dispersion using a three-in-one syringe. The first stage of restoration involved transforming the Class II cavity to a Class I by directly building up the proximal wall (Fig. 3). This increment was adapted to the cavity floor and matrix foil using a microbrush. The firm yet pliable consistency of BRILLIANT EverGlow allows efficient packing of the material with minimal pull back. The base of the proximal box was then filled using smaller 2 mm increments until it reached cavity floor level. A 20 second cure between each increment

COSMETIC & RESTORATIVE

FIGURE 1 - Cavity prep and sectional matrix

FIGURE 2 - Construction of proximal wall

FIGURE 3 - First incremental cuspal build up

FIGURE 4 - Sculpting tip wetted with ochre tint

was completed using a high power LED curing light (Coltolux, COLTENE). The adapted cavity was then restored using individual cuspal increments to recreate each incline (Fig. 4).

This was then gently brushed using a microbrush to remove excess until a good saturation was achieved. Following the final cure, the matrix band was fully removed and the restoration cured from each side for 40 seconds. Excess resin was removed using an excavator and white Arkansas stone in a slow handpiece.

The material was injected into the chosen cavity wall with firm and steady pressure to ensure full adaptation to the cavity walls. A technique called point sculpting was then employed. This involved dipping a fine tipped probe into a light brown tint (Paint on Colour, COLTENE, Fig. 5). The probe was then used to sculpt the fissures directly, the tint helping to lightly colour the fissures whilst simultaneously acting as a wetting resin when removing excess. Once the shape of the cusp was satisfactory, a microbush was then used to adapt the composite to the peripheral margins to create a more seamless junction. The cuspal increment was then cured. The same process was then repeated for the remaining cusps. To reproduce the more saturated and finer fissure stains, a dark brown tint was applied using an endodontic file (Fig. 6) at two points where the fissure patterns adjoin one another.

Following rubber dam removal, occlusion was checked and adjusted using an Arkansas stone in a fast handpiece. Finishing A very simple polishing protocol was employed using the DIATECH ShapeGuard Composite Polishing Kit (COLTENE). The cup was first used to broadly polish the cuspal surfaces followed by the pointed cone, which was used to more finely polish towards the fissures. The polishing wheel was then used in a light feathering motion to produce a very generous final lustre over the entire restoration (Fig. 7), and was particularly useful in reaching the proximal areas. Final occlusal checks were performed (Fig. 8) to ensure a comfortable bite for the patient that also conformed to maximum intercuspation. Shimstock holds on adjacent teeth were verified to those noted preoperatively.

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COSMETIC & RESTORATIVE

FIGURE 5 - K-file used to apply dark brown tint

FIGURE 6 - Cuspal build up and tints completed

FIGURE 7 - Finishing and polishing completed

FIGURE 8 - Final occlusal checks performed

ExaFinal appraisal BRILLIANT EverGlow proved to be a very pleasant material to use and handled very well to help produce a truly anatomical restoration that not only integrated well but also fully resolved the patient’s initial symptoms.

Inclusion of glass filler particles that have been reduced to below one micron allows for excellent polishability, especially when used with the ShapeGuard Composite Polishing Kit.

The unique shade system allows for simple and efficient restoration of posterior teeth and avoids the need to stock numerous different shades.

This feature along with the choice of additional opaque, translucent and bleach shades would also make BRILLIANT EverGlow an excellent choice for aesthetic anterior restorations.

About the author Minesh Patel graduated with honours from Barts and the London School of Dentistry in 2009. He then went on to graduate with a Master’s degree in Aesthetic Dentistry at King’s College London in 2013 whilst simultaneously completing a one-year surgical and prosthetic implantology programme based in Cambridge. He currently works in a fully private practice in Thames Ditton, Surrey and spends time teaching on various postgraduate programmes at King’s College London as well as lecturing around the country on clinical dental photography.

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COSMETIC & RESTORATIVE

PINK PETAL AN INTERVIEW WITH KARRIE VELKY RDH

Hands-free suction device holds the salive ejector in place, serving as an extra hand for the dental professional when no assistant is available. Zirc’s Pink Petal slides onto saliva ejectors to provide continuous, comfortable, hands-free suction with no additional attachments. By placing buccal side, the Pink Petal holds the saliva ejector right where it is needed-the back corner of the patient’s mouth-without obstructing view. The product is also single-use and is latex free. Here, Karrie Velky, the inventor of Pink Petal, discusses the reasons for the product’s development and why she wants to make other clinicians’ jobs easier and less stressful. suction tip, stopping the flow of suction and causing trauma. It’s great for elderly patients, they tend not to cough and choke on the water. Patients are still able to close their lips around the saliva ejector. It slides into and out of working position in seconds!

Q. How did Pink Petal come to be? Why did you invent it? When I started working in perio, where every pa tient is scaled ultrasonically, I was constantly running behind schedule because I was fumbling with the suction. I started searching the market for something that would hold the suction in place and protect the patient’s cheek from the suction-but that would still allow me to work on the entire mouth without hav ing to move the suction out of my way. I searched product books, I asked reps, I talked to colleagues, but came up with nothing. That’s when I decided I was going to make something that would solve all of my problems, and help keep me on schedule. I had a rough version of Pink Petal that I was using on every patient and they started asking if it was something new, stating how comfortable it made their appointment. Then, other hygienists started asking about it and wanted to try it. That’s when I realized I wasn’t the only one who struggled with this problem, and I decided I wanted to bring the product to market. My hope with Pink Petal is that it makes other clinicians’ days easier and less stress ful, and helps make patients’ appointments more comfortable.

Q. How can Pink Petal improve workflow in the operatory? The time it saves during the procedure-not to mention the time it saves during set-up, assembly of a suction or isolation device, and disassembly-is unmatched. With Pink Petal, you can suction handsfree without the need of an assistant plus you work more efficiently to stay on schedule. This is a cost effective product that works with your existing saliva ejector. No accessories to purchase. No upkeep. Most importantly, it drastically minimizes procedure time.

Q. hat challenges can Pink Petal help clinicians overcome? The main challenge that Pink Petal solves is that it is a suction tip holder that holds the slow suction for the operator when they need a third hand but don’t have an assistant to help. It also protects the patient’s cheek from being sucked up into the KARRIE VELKY RDH

REFERENCE: Dental Product Shopper

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COSMETIC & RESTORATIVE

AQUACARE A SELECTION OF APPLICATIONS

•

AquaCare increases bond strength with its texturing of the cavity surface.

•

Balanced, slim-line, fully autoclavable handpiece without bulky attachments.

•

Incredibly versatile across a wide variety of restorative dental procedures.

•

User-friendly with easy colour code cartridge system makes swapping between types of treatment effortless.

•

Minimal need for anaesthetics combined with the lack of vibration, heat generation and noise leads to reduced patient anxiety. AquaCare is recognised as a practice enhancing product.

•

Faster, more efficient cleaning for removing stains from all tooth aspects, even accessibly difficult pits and crevices, whilst also treating sensitivity. Patients love their brilliant smiles.

Fig. 1 Air abrasion from buccal and lingual to remove all debris. I use an AquaCare.” Dr. Lincoln Harris, restoringexcellence.com.au

Fig. 2 “Particle abrasion with 29μm Aluminium Oxide to remove aprismatic enamel and improve bond strengths prior to no prep direct bonding to close black triangles which were secondary to periodontal disease.” Dr. Jason Smithson

Fig. 3 “Always finish on 29μm Aluminium Oxide and Sylc.” Dr. Thomas Taha Fig. 4 “Cleaning and conditioning old composites with AquaCare 53μm Aluminium Oxide.” Dr. Jordi Manauta

Fig. 5 “Prepared with AquaCare only - no drilling 53μm Aluminium Oxide / 5 bar then Sylc for 30 seconds / 5 bar. ” Dr. David Gerdolle

After cleaning Aquacre Fig. 6 “Cleaning with Sylc.” Dr. Griya Ridha Raharja

COSMETIC & RESTORATIVE

DENTINE HYPERSENSITIVITY, REMINERALISING, IMPROVED BOND STRENGTH & STAIN REMOVAL

Fig. 7 ”Cleaning the composite leftovers and preparing the dentine surface for adhesion”. Dr. Ivan Raychev

Fig. 8 “Always finish on 29μm Aluminium Oxide and Sylc”. Dr. Thomas Taha

Fig. 9 Powered by Novamin, Sylc is a calcium sodium phosphosilicate powder, a highly biocompatible material which was initially developed as a bone conductive material. The bioactive glass material reacts with body fluids (saliva) to deposit hydroxycarbonate apatite (HCA), a mineral that is chemically similar to natural tooth mineral. This is one of the reasons why finishing the cavity with Sylc will occlude the dentinal tubules, reduce the water-contamination at the bonding interface with consequent hydrolytic degradation and reduce the risk of postoperative hypersensitivity.

NO MAGIC, JUST SCIENCE D

A: Dentine before air-abrasion. Note a smear layer-free surface with many patent dentinal tubules. (Confocal 3D topographic image). B: Dentine treated using AquaCare and Sylc bioglass. Note the presence of a smear layer occluding the dentinal tubules and covering the entire dentine surface. (Confocal 3D topographic image.) C: Dentine treated using Sylc and conditioned with a universal adhesive in self-etching mode. Note the smear layer partially covering the dentine surface. A Bioglass-rich smear layer is still available for conversion into apatite at the resin-dentine interface. However, most of the dentinal tubules are occluded entirely; the risk for postoperative sensitivity here is very low. (Confocal 3D topographic image).

D: Universal adhesive applied in self-etch mode onto a dentine surface treated with AquaCare and Sylc bioglass. Note the adhesive (ad) was able to form a sound interdiffusion layer (IDL: hybrid layer) but with very few resin tags (rt). In the confocal single-projection image (E) it is possible to observe a reflective material obliterating the dentinal tubules. It is most likely that the bioglass particles have penetrated the tubules several microns during the air-abrasion procedures.

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REFERENCE: Prof. Dr. Salvatore Sauro - Dental Biomaterials, Preventive and Minimally Invasive Dentistry, Universidad CEU-Cardenal Herrera, Valencia, Spain.

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PAIN CONTROL

SPECIAL PATIENT SERIES: TREATING THE PREGNANT PATIENT

In the context of oral health and dental treatment,

including

pregnancy presents a number of challenges. The

eclampsia and gestational diabetes (a condition with

dental practitioner must plan treatment with the

a bi-directional effect).

preterm

birth,

low

birthweight,

pre-

wellbeing of two patients in mind — one undergoing a series of complex physiological, hormonal and

Xerostomia

metabolic changes, and the other at the most

Some women experience reduced salivary flow during

vulnerable stage of their development — all the while alleviating the expectant mother’s natural concern for her offspring.

pregnancy, with common causes including gestational diabetes and dehydration. Expectant mothers are also more prone to mouth breathing — another cause of dry

This article aims to summarise the key changes in the pregnant patient as they relate to oral and dental care, outline best-practice guidelines for treating pregnant

mouth — for reasons that include: •

rate and respiratory rate.

women, and address common concerns about the safety of dental care during pregnancy.

•

hormones that begin to rise rapidly after conception. Oestrogen

promotes

vascular

proliferation

and

permeability in the gingival tissue, while progesterone’s immunosuppressant inflammatory

effect

reaction

subdues pathogenic

the

acute

bacteria.

Additionally, the composition of the oral microbiome can change dramatically during pregnancy, creating a more favourable environment for the growth of such bacteria.

•

Snoring and/or sleep apnea, aggravated by airway swelling and/or weight gain.

Dental caries Pregnant women are at greater risk of developing dental caries. The altered composition of the oral microbiome also favours the growth of cariogenic bacteria, while xerostomia limits the protective buffering and antimicrobial actions of saliva. If the expectant mother finds herself craving foods rich in

All play a role in the high prevalence of periodontal

sugar and fermentable carbohydrates, her risk can

disease in pregnant women, estimated to be at

increase even further.

least 40%. Research indicates that periodontitis is associated with adverse pregnancy outcomes,

Swelling of the airways due to oestrogen’s vasodilating effect.

The gingival tissue features receptors sensitive to Oestrogen and progesterone, key pregnancy

Displacement of the diaphragm by the expanding uterus.

ORAL HEALTH DURING PREGNANCY Periodontal diseases

Breathlessness caused by the increase in heart

According to the Centers for Disease Control

PAIN CONTROL

and Prevention (CDC), women with high levels of

use of drug therapies in pregnant patients. However,

cariogenic bacteria can transmit them to their infants,

this must be weighed against the risk to the mother,

increasing the risk of childhood caries.

who may suffer adverse consequences from untreated pain or infection.

Acid erosion

Guidelines vary by region, but the following provides

“Morning sickness” affects as many as 90% of

an outline of the U.S. Food and Drug Administration’s

pregnancies. It typically resolves after the first trimester,

(FDA) widely shared stance on commonly used drugs

but a small subset of women experience a severe and

in dentistry.

persistent form known as hyperemesis gravidarum (HG). Some women also experience acid reflux due to

Local anaesthesia

relaxation of the GI tract muscles, abdominal pressure

Amide-type local anaesthetics are generally considered

from the growing uterus, and dietary changes.

safe for use during pregnancy.

Frequent exposure to high levels of stomach acid

Lignocaine/lidocaine (Septodont Lignospan Special)

lowers the pH of the oral cavity, demineralises enamel,

and articaine (Septodont Septanest 1:200,000)

and facilitates enamel erosion. Weakened enamel is

are the local anaesthetics of choice for pregnant

also vulnerable to abrasion from toothbrushing —

patients in both the US and UK. They can be

something the woman may instinctively want to do

used to achieve profound anaesthesia with low

after vomiting.

concentrations of epinephrine and have high protein binding rates (articaine is highest), minimising the risk

Drug therapy considerations in pregnant patients

of foetal toxicity. Prilocaine, mepivacaine (Septodont

Significant changes occur in virtually every organ

Scandonest 3% Plain), and bupivacaine are also

system during pregnancy. The pharmacokinetic

considered acceptable.

properties of drugs should therefore be expected to change in various ways. For example, increases in

While epinephrine dosage should be kept as low as

total body water, blood volume and capillary pressure

possible, epinephrine can be beneficial in reducing

increase the volume of distribution of hydrophilic drugs,

systemic uptake of anaesthetic agents and decreasing

requiring higher doses to obtain appropriate plasma

the risk of toxicity. However, “plain” vasoconstrictor-

concentrations. Meanwhile, lower serum albumin

free formulas like Scandonest 3% Plain can be used if

levels can decrease protein binding and increase free

preferred for short procedures, or when epinephrine is

levels of many drugs, requiring lower doses.

contraindicated.

It is also assumed that all drugs can cross the placental barrier and affect the foetus, warranting conservative

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PAIN CONTROL

FOR TREATING THE PREGNANT PATIENT

Patient positioning

Forward planning

at greater risk of orthostatic hypotension, in which

Patients of childbearing age should routinely be encouraged to attend to all dental needs before planning a pregnancy where possible. It should be explained that their oral health plays an important role in the health of their baby, but options for addressing certain conditions may be limited once a pregnancy is underway.

sudden or quick changes in posture can induce a rapid drop in blood pressure and possible syncope.

This

warrants

extra

caution

when

moving the patient, e.g. lowering or raising the dental chair. The dental practitioner must also consider the size of the foetus. A heavy foetus, or multiples, can compress the vena cava and aorta in the supine position, leading

Oral hygiene education

to shortness of breath, a drop in blood pressure,

In addition to standard daily oral hygiene, educate the patient on protecting against

Pregnant women with lower blood pressure are

acid

erosion

—

often lesser-known risk in

bradycardia,

and/or

syncope. To

reduce this risk, the patient can be positioned on her left side with a pillow placed under her hip.

pregnancy. Patients should be advised to rinse with

In summary…

The oral health of the

solution

baking

soda and water after

mother

vomiting, and to wait In

cases

directly

impact the health of

before brushing their teeth.

can

her baby, so dental

practitioners should not

severe vomiting, as in

hyperemesis gravidarum, prescription

high-fluoride

dentifrice

topical application of a highfluoride varnish may be necessary for added protection, and is considered to be safe for mother and baby.

discouraged

care

the

pregnant

patient. While not without challenges,

most

treatment

goals can be achieved with a little extra consideration and careful planning.

Radiography There is a pervasive concern among pregnant women about the safety of dental x-rays during pregnancy. The International Atomic Energy Agency (IAEA) states that, when a lead apron and thyroid shield are used, the low level of radiation from a dental x-ray poses low risk to the foetus. That said, the risk is still present, and the IAEA takes the position that every woman of reproductive age should be treated as pregnant until confirmed otherwise. They strongly advise practitioners to display risk information in patient areas and to routinely ask about possible pregnancy.

from

providing the necessary

Watch treating pregnant patients by Dr. Barbara Steinberg

CLICK HERE

PAIN CONTROL

RECYCLING AND WASTE RECOVERY RECYCLING OF PHARMACEUTICAL GLASS AT THE SAINT-MAUR SITE

OUR TEAMS IN SAINT-MAUR WORK WITH A COMPANY SPECIALIZED IN GLASS RECYCLING TO RECYCLE THE GLASS FROM THE WASTE PRODUCED DURING OUR MANUFACTURING PROCESS. The type of glass used for our cartridges is a speciﬁc glass, different from food glass, and the recycling channels for this glass have yet to be developed. Instead of following the special industrial waste route, these cartridges will undergo a different recycling process to become glass wool and, to a lesser extent, to be recycled as food glass. The initial study conducted in partnership with “Recyverre” for the recycling of injectable cartridges focused on an industrial solution for Septodont and more speciﬁcally for the Saint-Maur site. A development of the glass recovery approach could eventually be envisaged on a larger scale, for example by involving more industrial players who may be in a similar situation or even by involving dental practitioners.

View Septodont full range online

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CLICK HERE

PAIN CONTROL

TRAUMATIC DENTAL INJURY:

WHY THE WORLD’S 5TH MOST COMMON CONDITION IS FLYING UNDER THE RADAR

Traumatic dental injuries are incredibly common — yet surprisingly overlooked. With prognosis heavily dependent on prompt action, accurate diagnosis and skilled treatment, it is essential that dental professionals have the expertise and strategies in place to manage dental trauma. Here’s what you need to know to rise to the challenge and secure positive

2. Injury of periodontal tissues: •

Concussion of periodontal tissue — injury to tooth-supporting structures without abnormal loosening or displacement of teeth.

•

Subluxation of tooth — injury to teeth-supporting structures with abnormal loosening but no displacement of teeth.

•

Extrusive luxation of tooth — peripheral dislocation and partial displacement of the tooth from its socket.

•

Lateral luxation of tooth — non-axial displacement of the tooth accompanied by alveolar socket fracture.

•

Intrusive luxation of tooth — central dislocation and displacement of the tooth into the alveolar bone, accompanied by alveolar socket fracture. Avulsion of tooth — complete displacement of the tooth from its socket.

outcomes for your dental trauma patients. What is traumatic dental injury? Traumatic dental injury (TDI) is physical injury of the teeth, their supporting structures, and/or the soft tissues of the oral cavity. According to The World Health Organization’s (WHO) 11th Edition of the International Classification of Diseases (ICD-11), TDIs can be mostly organised into two main groups. (1) 1. Injury of hard dental tissues and pulp: •

Enamel infraction — incomplete enamel fracture.

•

Enamel fracture — complete fracture confined to the enamel.

N.B: Maxillary or mandibular injuries and injuries to

•

Enamel-dentine fracture — complete fracture confined to the enamel and dentine.

The true prevalence of TDIs

•

Complicated crown fracture — complete fracture involving enamel and dentine with pulp exposure.

•

Uncomplicated crown-root fracture — complete fracture involving enamel, dentine and cementum without pulp exposure.

•

Complicated crown-root fracture — complete fracture involving enamel, dentine and cementum with pulp exposure.

•

Root fracture — complete fracture involving dentine and cementum, and pulp.

the oral mucosa are classified separately.

The true prevalence of TDIs has historically been difficult to establish. The WHO’s ICD-11 is just one of more than 50 systems used worldwide in public health and clinical research to classify, record and report disease and injury, including TDIs. The variation between systems has led to TDIs being reported inconsistently, incorrectly, or not at all. Were this not the case, it is estimated that TDIs would rank fifth in the Global Burden of Disease (GBD) Study’s list of the 300 most common acute and chronic diseases and injuries. At present, TDIs are not included in this list at all. (2)

PAIN CONTROL

However, some progress has been made with the success of a recent campaign to update the WHO ICD-11, bringing it in line with the widely used

Luxation injuries are the most common TDI affecting the primary teeth, while crown fracture — specifically an Ellis class IV fracture, in which the tooth becomes non-vital — is the most common TDI in the permanent teeth.(4)(7) The most commonly reported accompanying injury is trauma to the soft tissues of the mouth.(4) Complete tooth avulsion occurs in 1-16% of TDIs in the permanent teeth and 7-13% in the primary teeth.(4)

Andreasen classification system.(3) Experts do agree that TDIs occur with great frequency in children and young adults, more often in the permanent dentition than the primary dentition. (4) (5) TDIs represent approximately 5% of injuries for all ages, and up to 17% in children aged 0-6 years.(5)(6)(7)

Dental trauma causes and risk factors

Globally, one third of all pre-school children have suffered a TDI to the primary teeth, while one fourth of all school-aged children and almost one third of all adults have sustained a TDI to the permanent teeth. (8) Up to 90% of TDIs occur before the age of 19-20 years, with research indicating that those aged 10-14 years are at greatest risk.(4)(6)(7)(9)

The most frequent causes of TDIs are reported to be accidental falls and sports injuries, with less common causes including cycling accidents, traffic accidents, and physical violence. (4)(5)(9) Children in the most at-risk age group (10-14 years) tend to participate in sports and outdoor activities with greater frequency than younger children, and may do so independently of adult supervision. (9) For younger children, the main risk tends to arise from falls due to

There is some variation of prevalence by region, although it remains high worldwide. A national US survey indicated that one in four people aged 6-50 years had sustained a TDI.(6) In the UK, one in five school-aged children had experienced a TDI in the permanent anterior teeth.(6) In a Danish study cataloguing TDIs from birth, 30% of children sustained TDIs to the primary teeth and 22% to the permanent teeth, with every child sustaining a TDI by 14 years old.(6) Australia has an annual incidence rate of 20 TDIs per 1000 children aged 6-12, while Sweden’s annual incidence rate is estimated to be between 19 and 29

a lack of adequate motor control and coordination. (4) Among children, boys are approximately twice as likely to experience a TDI than girls. (4)(9) This can be explained by the tendency in many social and cultural contexts for boys to be more likely than girls to engage in demanding physical activity, aggressive play and contact sports. (4) There is notably less gender discrepancy in younger children, ostensibly because there is little difference at this

TDIs per 1000 individuals.(6)

stage between their capabilities and behaviours. (4)

In both the primary and permanent teeth, TDIs most commonly involve the maxillary teeth, particularly the incisors, thanks to their vulnerable position and angulation at the front of the mouth.(4)(5)(9)

Other predisposing factors to dental trauma are related to the patient’s anatomical features. Increased overjet, inadequate lip coverage, and class II occlusal relationships have all been cited as risk factors for traumatic injury of the anterior teeth specifically. (5)(9)

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PAIN CONTROL The importance of swift diagnosis and management TDIs have the potential to cause wide-ranging complications beyond the immediate pain and infection risk. The patient may experience pulp necrosis, pulp canal obliteration, ankylotic or inflammatory root resorption, damage to the supporting structures and, in some cases, complete loss of the affected teeth.(4)(10) In the primary dentition, TDIs can also result in enamel hypoplasia, discolouration, delayed eruption, impaction and damage to the developing permanent dentition.(9)(11) Complications may appear immediately after the injury, while others can take years to manifest. TDIs can also alter facial aesthetics and impair speech and nutrition. For children in particular, this can be damaging to psychosocial development, emotional wellbeing, self-confidence, and quality of life.(4)(9) With this in mind, accurate diagnosis, management and follow-up of TDIs is essential for a positive prognosis. However, as dental trauma is a challenging presentation that is not frequently encountered in day-to-day general practice, many practitioners could benefit from further training in, and frequent review of, TDI treatment protocols.(5) The International Association of Dental Traumatology (IADT) has published a comprehensive series of best-practice guidelines for the treatment and management of TDIs.(12) The following summarises a selection of their key recommendations, but we encourage dental professionals to review the guidelines in full. Clinical examination While the use of radiographic images should always be carefully considered and justified, it is important to note that some serious injuries, like tooth root and bone fractures, may present without clinical signs or symptoms. Additionally, the patient may not present until after clinical signs have subsided. The IADT notes that in the case of root fractures, crown/root fractures and lateral luxations, CBCT can be especially useful in determining the location, extent and direction of a fracture and should be considered. (13) Pulp condition and vitality Every effort should be made to preserve the pulp, particularly in the immature permanent tooth in order to allow continued root development and apex formation. (7)

In fractures and luxations, sensibility should be assessed as soon as possible with cold testing and electric pulp testing, and reassessed during follow-up. (13) Vitality should be assessed using pulse oximetry or laser/ultrasound Doppler flowmetry.(13) Avulsion of teeth In the avulsion of a permanent tooth, the treatment and prognosis are largely dependent on the maturity of the root and the viability of the periodontal ligament. First aid protocol calls for the tooth to be either replanted in the socket or kept in an appropriate storage medium, e.g., milk, saline, saliva, a tooth salvage box. If the tooth is replanted within 15 minutes, the periodontal ligament cells will most likely be viable. If appropriately stored for up to 60 minutes, there is likely to be some compromise of the periodontal ligament cells. However, after 60 minutes, whether stored or not, the cells are unlikely to be viable. (14) As TDIs happen outside of the dental environment, the prognosis therefore depends on rapid, appropriate action by the patient, guardian or first aid provider. It is generally agreed that an avulsed primary tooth should not be replanted due to the burden of treatment on the child, the risk of damage to the permanent tooth germ, and the risk of tooth aspiration. (11) Trauma to primary teeth The apex of the primary tooth root and the germ of the permanent tooth lie in close proximity to each other. Previous guidance has supported the immediate extraction of the primary tooth if the root is displaced in the direction of the germ, but the IADT now advises against this as there is evidence it can cause further damage to the germ.(11) Distress and anxiety Treatment of TDIs in children may be complicated due to a young patient’s fear and inability to cope with distress. Dental professionals should also keep in mind that this may be one of the child’s first dental encounters. Given the difficult circumstances, the risk of dental anxiety onset should be taken into consideration. The IADT notes that the “knee-toknee” examination technique can be helpful in smaller children, and recommends that the child is followed up by a specialist paediatric team with experience in minimising pain and distress in young patients.(11) You can find more advice on these topics in our articles Shaping Pain Perception and How to Deal with Young Patients’ Pain.

PAIN CONTROL

The challenge of preventing TDIs By their nature, it is difficult to predict or prevent TDIs entirely. However, dental professionals can help by raising awareness of common TDI risk factors. In younger children, that may involve educating parents on common causes of TDIs and preventative steps like the safe use of baby walkers, safe play behaviours, and adequate head/facial protection during play activities. With a significant number of TDIs occurring while engaging in sporting activities, players can reduce their risk by using mouthguards, while parents, teachers and coaches can encourage or mandate their use by children. In Australia, where sports injuries account for nearly 40% of TDIs, the New South Wales branch of the Australian Dental Association runs the Game On campaign to encourage this practice. (15) Dental professionals can do the same by getting involved by similar local campaigns and forming partnerships with local sports teams, schools and student sports associations. While we may not be able to prevent a TDI, we can improve the prognosis by raising awareness of how to appropriately respond. As the majority of childhood TDIs occur at home and in school, parents and teachers specifically must be educated in the correct way to deal with a TDI. (4)(5) The following are examples of how dental professionals can support awareness and encourage preparedness: •

Implementing media campaigns.

•

Providing educational resources for the home and classroom, such as the IADT’s Save Your Tooth posters.

•

Liaising with first aid providers regarding best practice and offering training in school or community settings.

•

Providing tooth salvage kits to schools and sports associations or making them visibly available in the practice.

•

While we don’t see dental trauma every day in practice, the high prevalence means that a TDI is never far away. By proactively raising awareness and arming yourself with best-practice treatment protocols, you can ensure that when you do encounter a TDI, you’ll be ready to secure the best possible outcome for your patient. References 1

https://icd.who.int/browse11/l-m/en

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30380-2/fulltext

https://onlinelibrary.wiley.com/doi/10.1111/ edt.12753

https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC8585915/

https://sbdmj.lsmuni.lt/141/141-02.pdf

https://onlinelibrary.wiley.com/doi/10.1111/ edt.12389

https://onlinelibrary.wiley.com/doi/full/10.1111/ edt.12574

https://onlinelibrary.wiley.com/doi/10.1111/ j.1600-9657.2008.00696.x

https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC8585904/

https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5045691/#:~:text=Complications%20of%20 injuries%20involving%20teeth,a%20few%20 years%20(4)

https://onlinelibrary.wiley.com/doi/full/10.1111/ edt.12576

https://www.iadt-dentaltrauma.org/for-professionals.html

https://onlinelibrary.wiley.com/doi/full/10.1111/ edt.12578

https://onlinelibrary.wiley.com/doi/full/10.1111/ edt.12573

https://www.adansw.com.au/News/Public/ When-it-s-game-on,-it-s-mouthguard-in

Directing patients, parents, educators and guardians to the IADT’s free ToothSOS mobile app, which offers emergency guidance in case of a dental emergency (available for iPhone and Android).

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ENDODONTICS

ENDODONTIC CASE REPORT JEAN-CHARLES CAMBRESIER

First lower, left molar showing a decay on the distal part with the symptom of irreversible pulpitis. Firstly, the decay is removed, and the tooth is built again with a temporary filling. Then the rubber dam is placed, and the access cavity is done.

Pre- Operative Photograph

The four canals were opened using the SX EdgeTaper Platinum. The coronal part was also widened using the S1 EdgeTaper Platinum. Working length and patency are obtained with a #10 K-file. A #15 K-file was used to confirm length and patency.

Thanks to the technology of EdgeEndo, I was able to prebend the file for comfortable shaping even if the opening was reduced. S1, S2, F1 and F2 EdgeEndo Platinum were brought to the full length of the canal.

During the cleaning of the isthmus between the mesial canals, an extra canal showed up. The shaping phase was fast and efficient using SX to the F2.

ENDODONTICS

The root filling was done with a single cone technique using the BUSA EndoSequence Bioceramic Sealer. The post op X-Ray shows great density and length of the root filling.

The cone fit Xray showed great length and a common exit for two of the three mesial canals.

JEAN-CHARLES CAMBRESIER Endodontist & Expert Dentist Gembloux, Belgium

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ENDODONTICS

CLINICAL CASE REPORT BY DR. ALLEN ALI NASSEH

A combined surgical and non-surgical approach to repair an external root resorption utilising a nanoparticulate bioceramic root repair material. Dr. Allen Ali Nasseh illustrates a case report for nonsurgical root canal treatment and the surgical repair of an extensive external root resorption defect.

Case report

Introduction

She explained that she was seeking a third opinion after being told twice that tooth No. 9 was not salvageable and had to be extracted. Clinical testing and evaluation revealed erythematous gingival tissues on the buccal aspect of tooth No. 9 with deep probing (+6 mm with BOP on the buccal and normal probing on the lingual).

The applications of bioceramic compounds in endodontic therapy range all the way from their nonsurgical use as a root canal sealer, a pulp capping agent, and a perforation repair material to their surgical applications for root repair and apiecoectomy procedures. The first bioceramic compound introduced, MTA (DENTSPLY Tulsa), was derived from Portland cement and has proven to be a valuable root repair material for surgical applications.1-3 More recently, medically pure nano-particulate bioceramic formulations (that have been engineered from the ground up) have improved on some notable shortcomings of MTA by addressing the clinical handling challenges associated with this first-generation material.4-15 In addition, the removal of heavy metals that can cause tooth staining in MTA-repaired cases has also been addressed with these newer second-generation formulations. This new family of compounds, known as EndoSequence® BC Sealer™, Root Repair Material (RRM™), and Fast Set Putty (Brasseler USA®), has shown significant clinical handling advantages over MTA for both non-surgical and surgical applications. Due to their nano-particulate size and viscosity, these materials can now be used as a sealer and/or filler for root canal obturation, as well as for the surgical repair of root defects and apicoectomies. This clinical case report demonstrates the use of EndoSequence bioceramic formulations for both the non-surgical root canal treatment and the surgical repair of an extensive external root resorption defect in a single central incisor.

A 26-year-old female presented with a chief complaint of discomfort and swelling around her front tooth (Figure 1).

Testing also revealed that all anterior teeth were within

FIGURE 1 - Radiograph of tooth No. 9 shows extensive root resorption in the mid-root region

normal limits to thermal and percussion test except for tooth No. 9, which was positive to percussion with severe and lingering response to cold. Upon radiographic examination, tooth No. 9 was diagnosed with extensive external root resorption. A history of protracted orthodontic therapy 10 years ago was noted in the patient’s dental history. A pulpal diagnosis of symptomatic irreversible pulpitis

ENDODONTICS was made, and the prognosis, given the large extent of the resorptive defect, was deemed guarded to questionable at best. Extraction was deemed the most predictable option. The patient, however, was very motivated and wanted to attempt to save her tooth despite the guarded prognosis. The non-surgical endodontic therapy was completed in a single visit using a combination of EndoSequence Root Repair Mate- rial (RRM) Putty in a barrier technique and EndoSequence Root Repair Material (RRM) syringe able formulation (Brasseler USA) to fill the entire canal in the following manner. Following cleaning and shaping to a size 70/.04 EndoSequence File (Brasseler USA), the tooth was further disinfected with full-strength (7%) sodium

hypochlorite. This was accomplished by using a negative irrigation system (EndoVac® MacroCannula) (SybronEndo) and a Forza V3 ultrasonic unit with an E11 tip/size 20 U-blade insert (Brasseler USA). Thereafter, a size 70/.04 EndoSequence BC gutta-percha cone (Brasseler USA) was fitted to the apex with tug back. The cone was then trimmed with a scalpel blade so that it would fit 4 mm short of the apex. A 4-mm plug of Endo- Sequence BC Putty was then condensed to the apex using the fitted cone so that a 4-mm plug of putty filled the apex, creating a barrier (Figure 2). The apical barrier technique has been described previously.16,17

FIGURE 2 - An apical barrier of EndoSequence bioceramic RRM putty was condensed down at the apex prior to back filling the rest of the canal with EndoSequence RRM syringe able bioceramic material.

FIGURE 3 - The access was restored with Fuji IX after backfilling the root canal with EndoSequence RRM syringe able bioceramic material.

FIGURE 4 - During the surgical visit, a sinus tract was noted on the buccal gingiva

FIGURE 5 - After raising a full thickness mucoperiosteal flap, a large resorptive defect was noted on the distobuccal aspect of the root of tooth No. 9

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ENDODONTICS

FIGURE 6 - Using a high-speed round bur and copious amounts of water, the defect was prepared, and all visible resorptive soft tissue in the root was drilled out until the root canal was reached, exposing the set EndoSequence RRM material inside the non-surgically filled root canal.

FIGURE 7 - After removal of the resorptive cells in the defect, the cavity was restored with the EndoSequence RRM putty material. The material was manipulated gently to the shape of the original root structure.

FIGURE 8 - The immediate suture placement and postoperative radiograph show the extent of defect after it was filled with the bioceramic RRM putty

ENDODONTICS The cone was then removed, and the entire remaining canal was filled with syringe able BC-RRM. The access was restored with Fuji IX (Figure 3). The patient was rescheduled for surgical repair of the external defect 2 weeks later.

The postoperative aesthetics were completely acceptable to the patient, and no tooth staining was noted as a result of the material used to repair this tooth internally or externally. Conclusion

The surgical appointment was not scheduled concurrently in order to allow time for the intraradicular cement to set and to evaluate patient response. The patient returned for the surgical root repair visit, and a sinus tract was noted on the buccal aspect of the tooth presurgically (Figure 4).

Extensive external root resorption and other aggressive forms of cervical root resorption are challenging when they cause significant root damage. These lesions can sometimes be monitored requiring no intervention at all. However, when endoperio involvement results in pulpitis, and later infection of the resorption defect, extraction of the tooth or surgical repair of the root are the only viable options.

A large external resorption defect was noted on the buccal aspect of the root after a full thickness intrasulcular flap was raised (Figure 5).

In cases where direct surgical access with good visualization of the defect can be achieved, the use of modern bioceramic formulations (which are easy to apply to the site and have demonstrated excellent biocompatibility, bonding, and hydrophilic qualities) may be an excellent clinical choice. In this clinical case, the use of nano-particulate premixed bioceramic formulations, both EndoSequence syringe able BC Root Repair Material (RRM) and putty were demonstrated.

Using a high-speed round bur and copious amounts of water, the defect was prepared, and all visible resorptive soft tissue in the root was drilled out until the root canal was reached, exposing the set EndoSequence RRM material inside the root canal (Figure 6). Once all the soft tissue was removed, the remaining preparation and the exposed root surfaces were conditioned with citric acid. The remaining root defect was then repaired with an equivalent amount of bioceramic putty trying to keep the natural curvature of the root (Figure 7), and the flap was sutured closed.

Long-term follow-up of the healing of the gingival tissues and acceptable esthetics were achieved in a tooth that was otherwise deemed unsalvageable. The ease of clinical handling during surgery and a lack of dentin staining were noted.

The immediate postoperative radiographs show the extent of the root repair with the putty in this tooth (Figure 8).

Further studies in this area are warranted in order to explore the true potential of this family of compounds in root repair applications, as well as all other aspects of endodontic therapy, where direct contact between biological tissues and biocompatible repair material is essential to success.

Following normal postoperative healing, the patient was evaluated at 6 months and 2 years, where the gingival tissue was observed to be fully healed, and probing was found to be within normal limits (Figure 9). At this point, the surgical repair procedure was deemed successful.

Dr. Allen Ali Nasseh received his Doctor in Dental Surgery (DDS) degree from degree from Northwestern University Dental School in Chicago, Illinois, in 1994 and completed his postdoctoral endodontic training at Harvard School of Dental Medicine in 1997, where he also received a Masters in Medical Sciences (MMSc) degree in the area of bone physiology. He has been a clinical instructor and lecturer in the postdoctoral endodontic program at Harvard School of Dental Medicine since 1997 and the Alumni Editor of Harvard Dental Bulletin. Dr. Nasseh is the President and Chief Executive Officer for the endodontic education company Real World® Endo (realworldendo.com). He is the endodontic advisor to several educational groups and study clubs and is endodontic editor to several peer-reviewed journals and periodicals. He has published numerous articles and lectures extensively nationally and internationally on surgical and non- surgical endodontic topics. Dr. Nasseh is in solo private practice (msendo.com) in downtown Boston, Massachusetts. DR. ALLEN ALI NASSEH

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ENDODONTICS

RUBBER DAM ISOLATION

The utilisation of rubber dam has always been taught to be mandatory for endodontic procedures however the indication for use extends also to restorative dentistry in assisting to perform procedures optimally, efficiently, and safely.

With the development of adhesive dentistry, the need for moisture control and adequate isolation is paramount for long term predictability and success with both direct and indirect dental procedures. The last few years with the Coronavirus pandemic have also raised unprecedented concern with dental practitioners exposed to the aerosol from patients mouths during clinical procedures. The use of rubber dam, along with mouth rinses and disinfection may offer benefits to safeguard and minimise transmission of air-borne micro-biological attack. The advantage of rubber dam include. Moisture control - preventing saliva, blood, gingival crevicular fluid from interfering with clinical procedures. This is particularly important for optimal adhesion when potential for moisture contamination can reduce or inhibit correct adhesion and cause premature failure of restorations. It is often quite a task to manage patients to prevent them from conversing, closing or swallowing. With the presence of rubber dam this precludes some of these possible adverse scenarios af-fecting any possible moisture contamination. Patient protection - the use of endodontic instrumentation and medicaments are prevented from being ingested or aspirated. It may also minimise any debris raised from removing old restorations, fractures from also inadvertently dropping in the oro-pharangeal area. The patient often finds it quite relaxing and comfortable once they are accustomed to the rubber dam.

Not having liquids at the back of their mouth needing to be constantly sucked up by high-speed evacuation may be much more comfortable. Visual access - the use of rubber dam allows access into the mouth, enabling lips, cheeks and tongue to be retracted away from the working region. This improves access and visualisation. The use of a coloured rubber dam with the contrasting colour can also allow better visualisation and photography of the teeth. It may also allow retraction of the gingival tissues with appropriate rubber dam clamps allowing unimpeded access to carious or subgingival margins. Minimisation of infection transmission - the creation of aerosols during dental procedures along with the proximity of the dental team exposes them to the potential of infective respiratory diseases and salivary microbiological load. The use of rubber dam provides an aseptic field and may assist to reduce the possibility of infection risks. Recently, a dental company has improved on current rubber dam offerings with the addition of a pre-printed rubber dam. This is a powder free latex rubber dam black in colour. HySolate Black Edition (Coltene) was created to allow for higher contrast and, thus, improved visibility during procedures. The black colour is nonreflective surface with no glare to contend with during treatment. The material consistency is medium in strength allowing excellent retraction of the tissues.

ENDODONTICS

The addition of the pre-printed template, marked on the rubber dam with the position of the teeth ensures that the holes are punched in the correct positions on the dam easily and accurately. Historically, one would have to mark the dam with a rubber stamp, which sometimes would rub off, so the saving in time and convenience is a welcome addition. For those that prefer a non-latex rubber dam the Hysolate Non-latex range has a Flexi-dam which may be preferred for those that don’t like the medium to heavy retraction from conventional rubber dams. This rubber dam is also excellent for the full arch isolation technique due to the ability to stretch without tearing the rubber dam.

About the author Dr Christopher Ho is a Specialist Prosthodontist who received his Bachelor of Dental Surgery with First Class Honours at the University of Sydney. He completed postgraduate studies in the Graduate Diploma in Clinical Dentistry in Oral Implants at the University of Sydney, a Masters of Clinical Dentistry in Prosthodontics with Distinction from the University of London and Doctorate in Clinical Dentistry in Prosthodontics from the University of Sydney. He is Fellow of the Pierre Fauchard Academy, Special Field Member of the Royal Australasian College of Dental Surgeons in Prosthodontics and a Fellow of the American College of Dentists.

It is often commented placement of rubber dam is a difficult procedure and the time to apply the dam is excessive, or it can feel uncomfortable for the patient. Utilising the correct technique and with the new rubber dams available on the market allows efficient application and can reduce clinical procedure time as well as safeguarding the clinical team from unnecessary exposure to harmful micro-organisms.

Dr Ho lectures extensively on aesthetic and implant dentistry both nationally and internationally. He is a visiting lecturer to the postgraduate programs at the University of Sydney, Adjunct Associate Clinical Professor at University of Puthisastra, Faculty member of the Global Institute for Dental Education and Visiting Lecturer at Kings College London, United Kingdom. He is Head of School of Postgraduate Dentistry at the Australasian College of Dental Practitioners. He is author of numerous publications, as well as Editor of the Wiley textbook “Practical Procedures in Aesthetic Dentistry” and “Practical Procedures in Implant Dentistry”.

View the Hysolate Dental Dam Product Brochure

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DR CHRISTOPHER HO BDS HONS (SYD), GRAD DIP CLIN DENT (ORAL IMPLANTS) (SYD), M. CLIN. DENT. (PROS) (LON), D. CLIN. DENT. (PROS) (SYD), MRACDS (PROS), FPFA, FACD

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ENDODONTICS

ROOT CANAL TREATMENTS FROM A TO X

COLTENE expands product range with practical CanalPro X-Move endomotor Whether tap dancing or slow waltzing, moving back and forth on the dance floor or circling in rotating movements - as is well known, tastes differ on the dance floor. With the same dynamics, dentists choose between reciprocating and continuously rotating systems in endodontics. With the CanalPro X-Move endomotor, the international dental specialist COLTENE is now further completing its extensive product portfolio – and offering fans of both variants an extremely practical alternative. Full freedom of movement The novel, wireless X-Move endomotor is characterized above all by its simple handling and great flexibility. The “x” in the name stands for the variable choice of practically x different movement protocols and treatment methods. The wireless unit can not only be conveniently moved around the chair or between different treatment units, it also works just as efficiently and reliably in both fully rotating and reciprocating modes in particular with the MicroMega OneRECI file. The movement patterns of other NiTi files from the COLTENE group, such as HyFlex EDM, MicroMega One Curve mini and the HyFlex / MicroMega Remover files for retreatments, are also stored. This makes the X-Move particularly intuitive and pleasant to use. With a diameter of only 8 mm, the delicate, matt black head of the contra-angle ensures a better view of the working field and at the same time facilitates photo documentation. The integrated isolation of the contra angle eliminates the need for additional sleaves. View products online

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Equally practical is the integrated Apex Locator for automatic length determination. With a speed of 2,500 rpm and a torque of up to 5.0Ncm, the flexible motor scores overall with a good price-performance ratio. With the CanalPro X-Move motor, the COLTENE group is expanding its range of instruments and dental materials for endodontics with another versatile tool. The dental specialist has always designed and implemented practical solutions. To this end, COLTENE collaborates with international scientists, practice owners, key opinion leaders and dental teams. Under the motto “Your Endo Guide”, the group has set itself the goal of supporting general dentists and endo specialists with experienced endo consultants, easy-to-use and intuitive products, and international training programmes. View the Coltene ‘Your Endo Guide’

CLICK HERE

REFERENCES: Coltène/Whaledent AG ‘https://newsroom.coltene.com/news/root-canal-treatments-from-a-to-x-coltene-expands-productrange-with-practical-canalpro-x-move-end/detail/ [Press release]

INFECTION CONTROL

INTRODUCING THE STATIM B G4+ FULLY AUTOMATED SPACE-SAVING MIRACLE

Compact vacuum autoclave STATIM B G4+ optimises sterilisation processes. Sterilisation is usually the last step in reprocessing, and in the case of instruments needed for critical applications, it is even mandatory. Therefore, correct execution as well as reliable performance of the autoclave is crucial. Flexible autoclaves with modern G4 technology combined with short cycles and a variety of digital functions. Users manage a host of other useful functions in their very personal customer portal on the device itself: Video tutorials conveniently guide them through simple maintenance tasks. Saved records can also be effortlessly supplemented with additional details. The smart technology allows for traceable load release as well as printing of bar codes. The WiFi-enabled connectivity of the STATIM B G4+ ensures protected data transfer and continuously fast user interface software updates.

Sterilisation in as little as 27 minutes Thanks to its smart configuration, the STATIM B G4+ is a high-performance vacuum autoclave that easily meets all current requirements for safety, flexibility, and efficiency. With the aid of modern G4+ Technology and a wide range of digital functions, this EN 13060 compliant steriliser enables the easiest instrument sterilisation of two large cassettes or up to 12 sterilisation pouches in as little as 27 minutes, which includes drying time.

With the practical remote technical support, trained technicians can access the device remotely directly after the practice has given its approval with the unique onetime access code provided. This effectively minimises or even completely avoids unnecessary downtimes in everyday practice.

Even textiles can be sterilised in this versatile unit. The well thought-out design of the STATIM B G4+ fits seamlessly into all existing sterilisation rooms. With this compact space-saving miracle, SciCan continues the success story and legacy of the internationally renowned STATIM cassette autoclaves.

Saving time prior to office opening The actual sterilisation process runs just as smoothly. The options for pre-heating and delayed starts save valuable time; for example when running Helix, vacuum or Bowie-Dick test cycles directly prior to the office opening for the day. Sensors also monitor the water level and quality in the built-in water reservoir. In addition to standard manual filling and emptying, these processes can also be configured to be automated as desired.

Communicative and intuitive to use The STATIM B G4+ has a large, 5-inch LCD touch screen. With an easy-to-clean glass surface and straightforward icon menu, it is easy to operate even with gloves on. The eye-catching LED light band around the display shows users in passing whether the unit is still running or if the current cycle has already been completed.

View the brochure online

VACUUM AUTOCLAVE

Thanks to all these features, the individual workflow of your own practice is even more optimised.

STATIM® B The Art of Sterilisation

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INFECTION CONTROL

FUTURA & CLASSIC STERILISERS

While the Futura has been the top seller in the Mocom range of Sterilisers, we’ll also take a closer look at the Classic and what this range has to offer. The Mocom Futura and classic have been a mainstay in the industry since 2013 with the Gen 1 range, and then the Gen 2 range more recently since 2019. Let’s look at some of the key features that set these units apart and make them one of the leaders in the Australian Sterilisation market.

The Classic is a more cost-effective unit with slightly less features then the Futura. We’ll talk through these features and differences between the two models. The Futura has a colour touchscreen for ease of use when navigating through the menu. The Classic has a more simplified LCD screen. Still simple to use but with a different function navigation system than the Futura. Water quality is a vital part of a Steriliser functioning correctly. While traditional sterilisers rely on demineralised water to operate, the Futura comes standard with a built-in demineralising filter meaning that tap water can be poured directly into the Futura. This saves the need to buy and store demineralised water bottles, saves on plastic waste, or the need to produce your own demineralised water via a slow desktop water distiller. This feature is unique to the Futura while the Classic range is more of a traditional

steriliser where demineralised water needs to be added to the water reservoir tank. Cycle time is important for busy Dental practices and both the Futura & Classic offer some of the fastest cycles in the market, including quick cycles for unwrapped hollow type A instruments. The Futura offers a heavy-duty vacuum pump for the quickest cycles, while the Classic has a performance vacuum pump for slightly slower cycles while still giving reliability. Both units include the delayed cycle start feature. All brands of Sterilisers that utilise a vacuum pump to remove air are required to run a Vacuum test and either a bowie dick or helix test (test type dependant on porous of hollow instruments being sterilised) to be performed once a day. The beauty of having this delayed start feature means that this Vacuum and Helix test can be programmed to start at any time of the day.

INFECTION CONTROL

With Mocoms the Vacuum and Helix test can be run consecutively so no manual intervention is required between the two cycles. Simply program the machine at the end of day to start the next morning prior to the practice opening. Place the helix device inside the chamber and press start. The two tests will then be complete when you arrive, allowing you to start Sterilising as soon as you arrive. This is a real time saver! The Classic & Futura also have the user management system which allows users to be tracked digitally to the cycle data via personal PIN codes. Cycle data is saved as PDF records on the memory of the units. By utilising the user management system, the users name is then attached to this record showing compliance with Australian standards and proving who released the steriliser load.

These cycle records can then be transferred simply via the included USB key on both models as a PDF record to a PC. Both the Classic & Futura also offer a free software allowing these cycle records to be transferred automatically to a PC, removing another manual process. This is done by utilising the included Wi-Fi or ethernet point and connecting the Sterilisers to the local network. With these simple but intuitive features, Mocom offers a well rounded and reliable solution to your Sterilisation requirements, making the process seamless and efficient. Mocom also offers a market leading 3 year or 3000 cycle warranty backing up their claim of being one of the most reliable Sterilisers on the market!

The vital parameters are displayed on screen before the unit asks the user to enter their unique PIN code. By utilising this feature there is no longer a requirement for a printer and keeping paper records in folders for seven years.

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View Mocom steriliser online

JIM OWEN Sales Relationship Manager Mocom Australia

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INFECTION CONTROL

UNCOVERING THE TRUTH BEHIND BIODEGRADABLE NITRILE GLOVES

Many disposable glove manufacturers claim to sell biodegradable nitrile gloves, but those claims are often false. The first step to understanding why is to clarify the difference between degradation, biodegradation and composting. Understanding the difference between degradation, biodegradation and composting Degradation is the breakdown of a material over time. Biodegradation is degradation resulting in a significant change in the chemical structure of a material caused by biological activity. Composting is biodegradation within a defined timeframe and specific disposal systems. It is measured by the metabolism of polymer carbon by microorganisms using international specification standards (ASTM D6400, ASTM D6868 and EN 13432). Key Takeaway Degradation is not the same as biodegradation. Materials that break down over time do not necessarily biodegrade. Furthermore, biodegradation is a natural process, whereas composting is a human-driven process. The facts about nitrile glove biodegradablity claims Nitrile is a fossil-based polymer and is therefore not biodegradable.Many manufacturers claim that additives to their gloves cause accelerated biodegradation - but there is no scientific evidence to support that an additive can change the molecular structure of nitrile. In reality, accelerated degradation occurs, which can result in the creation of microplastics that are harmful to humans and the environment. Nitrile degrades, it does NOT biodegrade. While the sources and data used to support nitrile disposable glove biodegradability claims may look legitimate, they are often misleading.

INFECTION CONTROL

Disposable nitrile gloves and the environment Life Cycle Assessments (LCAs) of disposable nitrile gloves reveal that most of their carbon footprint comes from manufacturing, NOT the waste generated after use.

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Visit ansell.com to learn more about sustainability.

INFECTION CONTROL

BEST PRACTICE FOR YOUR PRACTICE INDICATORS FOR WASHER DISINFECTORS

Machines are wonderful tools we have available to us to automate processes, reducing our workload and the potential for human error, but we all know that machines can malfunction. Sometimes without us necessarily knowing when the malfunction may have started occurring. Because while machines are smart and do a great job for us, sometimes they can’t tell exactly when something has gone wrong.

Let’s take our instrument washers for instance. The machine knows the program it needs to follow. In simple terms it knows it needs to do a cold water pre-rinse, maybe a second, then it needs to dose water at a certain temperature and introduce a certain amount of detergent to wash the load, then it needs to use a different kind of water at higher temperature and hold it at that temperature for a certain of period of time, before it dries the instruments and finishes the cycle. Smart machine. But let’s think about the things the machine can’t detect that may have wrong with that cycle. Does the machine know that the correct detergent at the correct concentration has been dosed? Maybe there’s a perforation in a line and no detergent has made it to the machine even though the machine assumes it dosed it. Does the machine know that the spray arms were all working ok? Does the machine know that the water quality is adequate, and that the hardness for example didn’t suddenly change which can adversely impact our instruments, or mean that our detergent dose wouldn’t have been adequate enough? Does the machine know that the trays and baskets weren’t overloaded? Were there spray shadows in the chamber?

The additional consideration in a dental practice is that quite often the washer doors are solid, so we can’t even see into the machine during the process to visually validate that everything is performing ok. The thing is, the point of using a test with anything in general, is to ensure the result of that test is giving us information that we wouldn’t have had already. For example, putting a thermometer in our oven doesn’t make much sense given the oven can monitor temperature itself. But using a meat thermometer does make sense because this gives us a piece of additional information the oven couldn’t tell us, that our meat has reached the right temperature on the inside. It is important in infection control to use independent process/cycle monitoring tools. For example, in our sterilising process using a process challenge device in every cycle is giving us additional information that the machine and package chemical indicators can’t give on their own. The same goes for routine monitoring of our washer loads. By using an indicator in every cycle, we have an independent means of back-to-back cycle assurance that all of the process parameters were met.

INFECTION CONTROL

I direct you to the most recent edition of the ADA Guidelines (fourth edition), page 36, that says “A suitable performance test (soil test) should be used in each load and the results recorded.” This is best practice for you and your facility. And it means you can monitor, cycle to cycle, that all process parameters are being met.

GKE Australia offer a unique product solution in our cleaning process monitoring indicators. We have different coloured indicators that respond differently depending on the detergent in use, the water quality and the performance of the machine. Which means we can offer a more tailored indicator to suit your facility and the processes you have in place. Contact us today to organise your obligation free product trial to ascertain the best coloured GKE indicator for you and your machine/s that you can purchase through Henry Schein. GKE Australia have been selling cleaning and sterilisation monitoring consumables in the Australian market for 25 years, so we have the experience and know-how to support you and your facility.

View products online

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LAUREN KONTUS BSc(EnvSC) Sales and Contracts Manager, GKE Australia lauren@gkeaustralia.com

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HANDPEICES

TURBINES BENEFITS AT A GLANCE

Optimum access Thanks to ergonomic 100°/19° head/knee angle combination

KaVo push-button chuck system with a retention power of up to 32 N for secure retention of the bur

Ceramic ball bearings for excellent quiet and low-vibration operation

Thermo- disinfectable and sterilisable up to 135 °C

Small head size Overall height 13.1 mm (standard version) or12.1mm (mini version) for good access and overview Plasmatec coating for a perfect grip and excellent hygiene 4-port spray with ultra-fine spray wetting for optimum cooling Glass rod light conductor with up to 25,000 lux for reliable detection of the preparation margins Low volume (only 57 dB(A)) to eliminate unpleasant noises for patients and treatment personnel Replaceable spray microfilter for effective and trouble-free spray cooling

Direct Stop Technology Bur stops in less than one second for greater safety during treatment Non-return feature effectively prevents contaminated debris and aerosol getting inside the housing around the head Optimum view thanks to offset light and spray outlets Maximum power of up to 31 watts for more efficient work High-tech FG chuck with carbide guide bush for optimum longevity

HANDPIECES

Minimal head size

Maximum power

MASTERtorque LUX

MASTERtorque Mini LUX

Head height 13.1 mm, maximum power up to 31 watts*, up to 57 dB(A), 4-port spray

Small head: head height 12.1 mm, 30 watts of power*, up to 59 dB(A), for standard and miniature burs, 3-port spray

M9000 L: Mat. no. 1.008.7900

M8700 L: Mat. no. 3.001.0000

M9000 L chocolate brown: Mat. no. 1.007.9900 M9000 L anthracite: Mat. no. 1.007.7100

Third-party Couplings MASTERtorque LUX

MASTERtorque Mini LUX

Like M9000 L, fits Sirona click&go coupling**

Like M8700 L, fits Sirona click&go coupling**

M9000 LS: Mat. no. 1.008.5400

M8700 LS: Mat. no. 3.001.0600

* At 3.5 bar. Power depends on drive pressure and other parameters. ** Registered trademark of Sirona.

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INSTRUMENTS

HISTORY OF KEY OPINION LEADERS A TRADITION OF COLLABORATION

1993 DANIEL BUSER BUSER PERIOSTEAL Daniel Buser has more than 30 years of experience within the oral and implant surgery field. The impressive results made by the implant specialists at the University of Berne, by using up to date procedures and techniques, have been documented in long-term studies. Notable results from Buser’s team are still published in leading international journals, even after 10 to 20 years have passed. Stomatology is a prestigious field where interdisciplinary collaboration is particularly important, as well as high-quality products supplied by material manufacturers that are kept up to date by the latest surgical techniques and innovative industry achievements. Almost 25 years ago, Buser partnered with Hu-Friedy to design and create surgical instruments, including the periosteal, that continue to be found in every dental office today. Like the Gracey Curette, The Buser Periosteal is a best seller that is found in most instrument manufacturer’s product portfolios worldwide.

Active part-code: HF-PPBUSERX

1995 MAURO LABANCA LABANCA PLUGGER Thinking about new procedures and techniques, the nineties were a developmental period for GBR. Despite many studies about new biomaterials and their surfaces, minimal attention was given to the most effective way to handle them. During Labanca’s daily procedures and consultations, several different instruments were used to compact biomaterials inside of bone defects but none of them were ever correct. During this time, Labanca was fascinated by the Hu-Friedy brand. Because of this, he suggested the development of a plugger with several functions. This plugger would be smooth enough to avoid damage to the biomaterial surface, act as a spatula on its lateral side to model the graft properly and have a large ending part in order to properly compact the graft. Hu-Friedy debuted the product in 1995, and together with Labanca they continue to develop additional instruments which are used to gain a better and more effective regenerative procedure.

Active part-code: HF-PLGLABANCAX

INSTRUMENTS

IPR SET | 4594 FOR SIMPLE IPR PROCEDURES

For interproximal enamel reduction (IPR) according to Dr. Drechsler. These days, interproximal enamel reduction (IPR) is increasingly used in all sectors of modern orthodontics. This not only applies to all fixed buccal and lingual appliances but also to treatments with aligners. Interproximal enamel reduction has become an invaluable aid in orthodontics, preventing extractions and ensuring successful straightening of teeth, especially in adults.

A new, professional IPR Set has been developed in close collaboration with Dr. Thomas Drechsler. This kit combines easier handling with an optimised clinical treatment, considerably facilitating the work of orthodontists and dental assistants. The patented oscillating discs come clearly arranged in a modular storage box with a practice-orientated design. Suitable for sterilisation, this ergonomic storage box meets all criteria of efficiency and hygiene in dental practices. Thanks to the different disc sizes and their logical arrangement in the storage box, it is now guaranteed that the amounts of inter-proximal substance that usually need to be removed (i.e. 0.2, 0.3, 0.4 or 0.5 mm) can be defined and achieved even more accurately. A range of oscillating discs - coated on one or both sides - are available to remove any amount of interproximal substance between 0.2 and 0.4 mm as required. This easy step-by-step technique not only produces reliable, reproducible results, it also pro-vides greater comfort to both orthodontist and patient during enamel reduction.

German patent DE 197 54 879

Scientific advice: Dr. Thomas Drechsler, Fachpraxis für Kieferorthopädie Orthodontic Clinic · Wilhelmstraße 40 65183 Wiesbaden www.kfo-wiesbaden.de

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INSTRUMENTS

Fig 1. Gentle, manual separation of the contact point: first of all, a thin abrasive strip WS37EF with honeycomb design coated with extra fine grit (yellow) is inserted between the two teeth. Fig 2. This is followed by a slightly thicker strip WS37 (0.13 mm) coated with medium grit (blue). Fig 3. Once the interproximal contact has been eliminated with the abrasive strips, the first oscillating disc OS1FV (0.13 mm, coated on one side only) can be used without jamming. The oscillating angle of the discs is 30° (15° in each direc-tion). The sequence of use is such that each disc is 0.05 mm thicker than the previous disc. This allows a smooth, gradual increase of the interdental distance in complete safety. Fig 4. This is followed by the oscillating disc OS15FV, which is – like its predecessor – only coated on one side. This allows the selective removal of dental enamel on one side of the tooth only, according to requirement. Oscillating discs with coating on their rear side only are available for work on distal surfaces (figure numbers feature the letter “H” instead of “V”). If an even substance removal on both sides is required, the oscillating disc OS15 with coating on both sides (thickness: 1.5 mm) is recommended. If you intend to reduce the dental enamel by a total of 0.2 mm, just use the discs in the first section of the storage box marked 0.2. To enable the removal of the exact amount of enamel, the thickness of the oscillating discs is 0.05 mm less than the required dimension. This is because the enamel reduction is followed by an interproximal polishing step.

Together, these two steps will result in the removal of the exact amount of enamel required, eliminating the need for a subsequent dimensional check. If you wish to reduce the dental enamel by 0.3 mm or 0.4 mm, use the discs in section 0.2 first and work through the subsequent sections – starting at the top of each sector – until you have reached the last disc at the bottom of the section that corresponds to the required target size: Fig 5. Oscillating disc OS2OF coated on both sides (thickness: 0.20 mm), Fig 6. … oscillating disc OS25M coated on both sides (thickness: 0.25 mm), Fig 7. … oscillating disc OS1M coated on both sides (thickness: 0.30 mm), and Fig 8. … finally, the oscillating disc OS35M coated on both sides (thickness: 0.35 mm) is used. Fig 9. Result after use of the oscillating discs. Fig 10. The IPR Set also contains a rotary diamond instrument 8392.314.016 (red ring) if the interproximal enamel is to be reduced by more than 0.5 mm. This instrument is stored in the section marked 0.5. Applied horizontally, this finisher has a particularly short working part to enable quick, yet precise interproximal enamel reduction between neighbouring teeth. Fig 11. Stored in the “contouring” section of the IPR Set, the instrument 850.314.012 is used prior to final polishing for contouring, smoothing and bevelling of edges and beads. This instrument is designed to give the dental surfaces a natural, aesthetically pleasing look. Fig 12. After polishing, apply fluoride to the enamel to conclude the treatment.

INSTRUMENTS

Recommendations: •

•

The use of an air motor is also possible () 20.000 rpm).

•

Start the oscillating discs before they are applied to the tooth.

•

Insert the segmented discs from occlusal and guide down slowly.

•

Make sure to use sufficient waterspray coolant at all times (at least 50 ml/min.).

•

Segmented discs with coating on the face side are identified by the letter “V” (standing for “vorne”, the German word for “face side”) on their shanks, whereas discs with a coated rear side are marked with the letter H (= “hinten”, German for “rear”). The thickness of the disc is also laser marked on the shank.

•

WS37EF

The discs are used at maximum setting of the micro motor () 40.000 rpm).

•

Elimination of the interproximal contact

The segmented discs are exclusively designed for use in the oscillating Komet contra-angle (OS30).

WS37

IPR 0,2 mm OS1FV.000.140

0,13 mm

OS1FH.000.140

0,13 mm

OS15FV.000.140

0,15 mm

OS15FH.000.140

0,15 mm

OS1F.000.140

0,15 mm

IPR 0,3 mm

Segmented discs coated with medium diamond grit can be identified by a blue ring, whereas discs coated with fine diamond grit bear a red mark.

OS20FV.000.140

0,20 mm

OS20FH.000.140

0,20 mm

OS20F.000.140

0,20 mm

OS25M.000.140

0,25 mm

IPR 0,4 mm

To complete the treatment, the interproximal enamel should be polished and fluoride should be applied to the enamel.

OS1M.000.140

0,30 mm

OS35M.000.140

0,35 mm

IPR 0,5 mm 8392.314.016 Advantages: •

Much faster and more effective than manual enamel reduction with diamond strips.

•

No risk of injury to soft tissues.

•

The enamel can be reduced by exactly the required amount.

•

Patented oscillating discs for unobstructed view and excellent chip removal.

•

Clearly arranged, sterilizable instrument tray

Contouring 850.314.012

ASR Set 4594

OS30

Scientific advice: Dr. Thomas Drechsler, Fachpraxis für Kieferorthopädie Orthodontic Clinic · Wilhelmstraße 40 65183 Wiesbaden www.kfo-wiesbaden.de

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INSTRUMENTS

CLINICAL CASE: LUXATOR

The Luxator extraction instrument product range enhances the outstanding selection of high quality extraction instruments from Directa. Modern techniques as implants requires instruments and equipment offering

possibilities to achieve fast healing and placement of direct implants after extraction. “ I use the Luxator as a shoe horn - so easy and efficient.”- Frédéric Chiche

View products online FRÉDÉRIC CHICHE

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DENTAL SOLUTIONS

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