dentalblogs.com » Dental Restorations

Impression and Restoration Technology in Dentistry

cranham — Fri, 12 Oct 2007 12:41:29 +0000

The next big boom in clinical dentistry may be how we take impressions. There are a lot of companies working on digital impressioning now. If it catches on, it will completely replace how we do impressions and how labs fabricate crowns. It’s going to be the next real rage. I had a chance to see the Brontes by 3M last summer. It’s certainly one of the best I’ve seen, but I can’t predict what the saturation will be. Check them out online and see what you think.

The other thing that’s interesting is the E4D, which is the emerging chairside unit that competes with Sirona. I’ve done beta testing with the E4D for the past few months. The software, the laser scanner – it has very interesting benefits.

Great insight from Bob Marcario on amalgam’s

Administrator — Wed, 31 Jan 2007 22:36:07 +0000

New Isolite2

Administrator — Mon, 05 Jun 2006 14:20:24 +0000

I purchased the original Isolite and rarely used it due the bulk of the unit and the separate fiber optic cord and light source. These problems have been solved with the new i2. This device controls illumination, retraction, and isolation. It is lightweight and easy to insert in the patients mouth. The amazing thing is that my assistant often sits and watches me do a procedure. There is nothing for her to do. The device requires some installation and sells for $1495 from www.isolitesystems.com

The CEM luting agents

karl — Tue, 09 May 2006 18:25:03 +0000

A luting agent may be more than a cement

Until the beginning of the 1970’s all the profession had was zinc phosphate cement (Mizzy and DeTrey), polycarboxylate cement (Durelon) and zinc oxide and eugenol (Fynal). The use of these materials has fallen way off the charts in terms of popularity. Polycarboxylate represents about 15% of the sales where as zinc phosphate cement has fallen to 5%. In addition, zinc oxide and eugenol based cements are not recommended due to their potential for killing the odontoblastic cells.

The replacement over the last 10 to 15 years has been glass ionomers and resin modified glass ionomers as well of course, composite resin cements. More recently, the trend has been moving towards the “CEM” luting agents. These are classified as glass ionomer containing diacrylates.

There are many reasons for the changes. However, one of the important ones relates to the indirect restorative material itself. Ceramic full crown restorations as well as veneers require an agent that till contribute to the fracture resistance of the restoration. When all ceramic restorations for example were cemented with zinc phosphate cement, the fracture rate was very unacceptable. The newer cements tend to form a mechanism for the homogenous transfer of masticatory stresses.

The question related to this change is this: if the composite resin and glass ionomer cements (and RMGI) were so successful in terms of extended clinical longevity, why should we change to this new class (“CEM”) of luting agents? Examples of this type of luting agent included:

Unicem 3MESPE

Maxcem Sybron/Kerr

Monocem Shofu

Fuji Cem GC America

There are several reasons, but perhaps the most obvious is “ease of use”. By all comparison each of those listed about are far easier to mix, place and seat. In addition there are numerous other great properties which include:

No specific treatment of the prepare tooth

High fluoride release

No postoperative sensitivity

Potentially forms a hybrid zone

Bond strength to dentin of 6-8 MPa

Easy cleanup

One-step

Self etch

Can be used for everything except veneers

2 minute working time

3-5 minute setting time

Bonds to ceramic agents

Sounds like the near perfect luting agent and clinical experience is highly acceptable. But wait a moment……no clinical data; short-term or long-term. That’s the only disappointment.

Interface – Ceramic/Enamel/Dentin Primer

Administrator — Tue, 07 Mar 2006 17:11:13 +0000

A patient of mine chipped the incisal porcelain on one of her veneers. This has been nearly impossible to repair and a complete remake was usually necessary. Interface from www.apexdentalmaterials.com, allows a doctor to prepare porcelain, dentin and enamel for bonding without hydrofluoric acid.

The chipped porcelain was first sand blasted.

Liquids A and B were mixed for 30 seconds and applied for 10 seconds followed by a 5 second air drying.

A coating of Simplicity 2 is applied, air thinned, and light cured for 10 seconds

A second coat is applied and not light cured.

Shade B1 Z100 Body

Finish and polish.

Tri-Clip – One step sectional matrix

Administrator — Wed, 01 Mar 2006 17:34:51 +0000

I just tried these one step sectional matrixes and absolutely love them. They have the clamp, sectional matrix and wedge in one preassembled unit. Very fast and easy to place. The clamp wedges the teeth apart and another silicone wedge seals the box from below. They are $85 for fifty or $1.70 each. Info on www.Triodent.com

Short An Assistant???

Corine Leech — Thu, 09 Feb 2006 03:32:42 +0000

In a dental practice there is sometimes too much to do for one assistant, even two assistant. Well if you have not checked this out you should: www.isolitesystems.com . It is like an extra set of hands, retracts the cheek, keeps the tongue out of the way, allows the patient the comfort of a bite block to rest on, lights you field of vision( light adjusts to prevent curing of materials permaturely) and has great suction in it. I have one practice I work with that lost a chairside assistant , got the Isolite and still have not hired back the second assistant. Just a thought for those of you who may need a little more help chairside. It works great in hygiene also if you are doing the sealants in your office.

The wrong story on zinc oxide & eugenol

karl — Tue, 17 Jan 2006 19:36:27 +0000

The wrong story on zinc oxide and eugenol:

Recently there have been instances whereas the clinician has been given misinformation as it relates to zinc oxide and eugenol. Specifically Gordon Christensen and more recently Frank Spears have stated that temporary restorations made of zinc oxide and eugenol will not interfere with the polymerization of composite resin restorations subsequently placed. Both sources stated that any residual eugenol associated with the temporary restoration would eventually dissipate.

This statement is not true. First, zinc oxide reacts with eugenol to form zinc eugenolate, which is a chelate compound. This compound crystallizes to give a matrix of long sheath-like crystals that bind together the remaining unreacted zinc oxide (Restorative Dental Materials, University of Michigan, CV Mosby Company). Unreacted eugenol is absorbed by both the zinc eugenolate and the unreacted zinc oxide. The hardened mass therefore consists of a mesh-like matrix of zinc eugenolate crystals binding together particle of zinc oxide and the excess eugenol absorbed by both the zinc eugenolate and zinc oxide.

The point is this: the excess eugenol remains in a free state (unreacted) and will remain in the material indefinitely. Unless all of the residual material is removed prior to placing the dentin-bonding agent, the polymerization process stands to be impeded.

Clinically there are a couple of ways that the problem can be prevented. One way would be to hybridize the preparation before the zinc oxide containing temporary material (IRM) is placed. Obviously, this may not always be a practical approach, depending upon the specific procedure being carried out. The other way to deal with the matter is to sand blast the preparation (Danville Microetcher) immediately after the zinc oxide and eugenol temporary has been removed. The final and third way is to use “no- eugenol based temporaries. Unfortunately most of the eugenol-free temporary agents do not have the same quality of handling as do those that contain eugenol.

Karl Leinfelder

Upcoming text on Esthetics vs Science

karl — Wed, 04 Jan 2006 13:49:51 +0000

Title: Composites, Adhesives and Beyond
            Dr Douglas Terry of Houston, Texas and I are developing a textbook on everything dentally esthetic. This publication is designed to offer the clinician an unprecedented level of comprehensive information related to various types of restorative systems employed for treating patients. These include the following: composite resins, dentinal adhesives, indirect composite resins, all types of ceramic systems currently available, glass ionomers, luting agents, bleaching, cavity preparations and associated auxiliary materials. After approaching each material from a historical point of view the pertinent physical and mechanical characteristics will be discussed with emphasis on clinical significance. This then will be followed by examples of clinical applications and procedures.
            A final rough draft of the first chapter (composite resins) has been developed. Consisting of more than 16,000 words and about 100 pertinent references, the first chapter includes nearly 40 illustrations. We anticipate publishing this effort in Quintessence International sometime this year.
            Related to this matter, I am looking for advice from clinicians who participate in this forum about the text. In this regard I would like to offer the first chapter for review by anyone that may be interested in this future publication. Simply contact me by e-mail (kcullie@aol.com) and I will send (by e-mail) you a copy of the first chapter. In return I would appreciate any suggestion that you may have for improving the content; both generally and specifically.
            I realize that this is an unusual approach to writing a book. However, many texts are written without appropriate criticism before the manuscript gets to the publishers. If you have any questions about this matter, please feel free to contact me.
Karl Leinfelder

Razor Burs from Axis Dental

soileau — Tue, 03 Jan 2006 23:34:18 +0000

I just tried these burs from Axis Dental called Razor burs. They are fantastic! They cut through both the porcelain and metal very easily. There was no chatter noticed. I used them with both NSK and KaVo electric hand pieces.

Tony

Gradia Composite Veneers Easy Case

soileau — Wed, 14 Dec 2005 10:10:47 +0000

This is a case I did yesterday. Lady could only afford to pay for wax blueprint and 3 composite veneers. This case tool me a little over an hour. We scheduled an hour and a half but we finished way early. The key is to have a wax blueprint and then make the stint with windows. After that it is just a matter of filling in the stint and sculpting, cure, place the next stint, sculpt, ……. You do have to choose the right enamel OPACITY and dentin COLOR. But if you choose that correctly, the rest is easy. I polish with a latch type Robinson brush and MI Paste. The hard part is getting the texture of the composite to match the texture of the rest of her teeth. Cool case. She cried when we were done. Not a big deal to us but a very very big deal to her.

Feel Free to Ask! Dental Blogs is about sharing ideas without confrontation.

soileau — Tue, 01 Nov 2005 14:44:40 +0000

We have all been on other forums where anyone can post anything about anyone. This often leads to angry and self-ritious grandstanding. In other words, confrontation for the sake of protecting ones turf, as opposed to simply sharing ideas for the simple sake of helping others. All the authors of this forum have the obligation and responsibility to maintain an environment where anyone feels comfortable asking a question or sharing a view without being ridiculed or interrogated. There are too many forums where this mentailty exist. The end result is that only a few meaningful post are presented which are then attacked and no one else post anything. That will not happen here. If you have any question or want to share an idea in a thoughtful way, please do so. That is what this forum is about. We have the best and brightest here and they truly want to help others achieve the same success that they have. They willingly share their ideas and experiances without any form of compensation other than the warm feeling of knowing they made a difference. So I personally invite all of you to ask or share whatever you wish because I bet you will have more to teach me as I have to teach you.

Tony

Pulp Capping: Direct and Indirect

karl — Wed, 21 Sep 2005 12:23:59 +0000

During the last ten years, there has been considerable discussion by practitioners regarding pulp capping. Traditionally, dental schools have recommended that calcium hydroxide (Dycal, Life etc.) was the best agent for capping exposed pulps. In recent years, Dr. Charles Cox (1993) formerly at the University of Alabama conducted a clinical study using monkeys to re-evaluate this concept. His findings suggested that calcium hydroxide might not be the agent of choice. Instead, he proposed that the vital pulps exhibited a higher level of vitality if first subjected to phosphoric acid followed by an application of a dentin-bonding agent. In fact, it was suggested that calcium hydroxide be eliminated as an intermediate agent under the restorative material.

The impetus for his studies was derived from earlier investigations of both Branstromm and himself as well. Both investigators have demonstrated clearly that the inflammation of the pulp could be minimized or even avoided by denying the invasion of microbes into the pulpal chamber. Today this microbe free concept is widely accepted by the majority of the profession.

Subsequent studies dealing with acid etching and subsequent application of a dentin bonding agent however, have not been in total accord. In fact, the overwhelming majority of them (Gwinnett 1998, Costa 2001, Stanley 2001,etc.) have demonstrated that acid etching of pulpal tissue following by an application of dentin bonding agents is strongly contraindicated. Under most conditions, pulpal response to calcium hydroxide was far superior to that associated with application of phosphoric acid and a dentinal adhesive.

One of the major concerns to an application of the dentin-bonding agent to pulpal tissue was published by Gwinnett. Specifically, he demonstrated that some of the ingredients of the bonding agent actually diffused into the pulpal chamber as a globule or foreign body. Continued histological evaluations demonstrated that although the non degradable globules were surrounded by macrophages, these foreign bodies could not be absorbed biologically. Instead, they remained in tact. The concern then is that over an extended period of time these monomer globules could eventually end up in some lymph gland.

More recently, still another recent publication has condemned the use of acid etching and bonding directly to pulpal tissue. The conclusion of this paper stated that calcium hydroxide continues to be the most reliable and clinically successful agent for treating small pulpal exposures. The reference is as follows:

Accorinte MLR, Loguercio AR, Muench A, de Araujo VC. Adverse effects of human pulps after direct pulp capping with the different components from a total-etch, three-step adhesive system. Dent Mater (2005) 21, 599-607.

Significance: All of the bonding agent components as well as composite resins should be avoided for pulp capping. Calcium hydroxide should be the first choice for pulp capping.

Calcium hydroxide is extremely effective in killing those microbes that are associated with the caries process. Simply by elevating the pH to a level of 10.0 or higher, the dissociated hydroxyl ions dramatically change the physiologic environment normally conducive for sustaining those microorganisms.

Calcium hydroxide is also the material of choice in conjunction with indirect pulp capping. When it is necessary to retain small masses of caries so as not to cause a pulpal exposure, this agent immediately begins to necrose the residual microbes, thereby arresting the caries process. Incidentally, as related to all other systems such as polycarboxylate cement, glass ionomers or zinc oxide and eugenol, calcium hydroxide is the most effective agent available to the clinician.

Top 25 Dental Products -Template

Administrator — Mon, 19 Sep 2005 16:54:27 +0000

This is absolutely the best material to make a matrix for provisional restorations. Many dentists use alginate, putty, or a vacuum-form matrix. These techniques either compromise time or accuracy. Template makes a very accurate quadrant template and sets in 30 seconds with no flash. It is dispensed in a 50 ml cartridge that fits any standard cartridger dispenser.

Template is from Clinician’s Choice 1-800-265-3444

Wax Blueprints for Provisionals with Premade Wax Forms

soileau — Sat, 06 Aug 2005 16:15:47 +0000

For all my provisionals in the anterior and most in the posterior I use a wax blueprint or wax-up. We do these in house by myself or my assistant Andrea does them for me. We use pre-made wax forms from Lab Innovations, www.labinnovations.com, which allow us to quickly and easily create amazing wax-ups. This particular wax-up took 20 minutes. Listen to the voice attachment for an in-depth description of each step.

This is what my set up looks like for waxing.

Close up of hand carvers.

Wax forms.

Close up of wax forms.

Pre-op model.

Wax form tried for fit.

Facial view.

Carved to place.

Tacked with wax.

Begin Lingual Fill.

Start of Lingual Anatomy.

More Lingual Anatomy.

Start of Facial Fill.

Round Line Angles.

Refine Lingual Anatomy.

Finish Facial View.

Finish Lingual View.

Listen to Voice attachment

on site training for CEREC

Gary Radz — Sat, 23 Jul 2005 06:41:13 +0000

just spent 2 days with Dr. Gary Waldron doing on site training for my CEREC 3D………made a huge difference in my speed and ability with the machine. I’d highly recommend him for anyone who wants to increase their proficiency with the CEREC unit.
he was in the office for 2 full days while we treated patients. On our second day we prepped, designed and delivered 6 units. Of the six units, we did quadrants of 2 onlays on 2 different patients.
Contact me at radzdds@aol.com if your interested in Dr. Waldron’s contact info.
Gary

Fourth Dentistrytogo Podcast with Dr. Julian Holmes

Administrator — Fri, 08 Jul 2005 08:55:07 +0000

In this 30 minute interview, Dr. Tom Hedge interviews Dr. Julian Holmes of Capetown, South Africa. They discuss the fascinating topic of ozone treatment of teeth and soft tissues. This technology will change the what we do dentistry once the FDA approves it for use in the U.S.., the only country in the world where it is not being used.

Visit The Kavo Website

Download The Podcast Interview

Third Dentistrytogo Podcast with Tom Gildersleve

Administrator — Thu, 07 Jul 2005 22:45:29 +0000

Dr. Tom Hedge interviews Tom Gildersleve of Harmony Dental Lab in Jacksonville, Florida. In this 30 minute interview, they cover digital technology and how it impacts dentist to laboratory communication. There are many great tips on an ideal laboratory relationship.

Visit The Website

Download The Podcast Interview

Vita Easyshade

Administrator — Wed, 29 Jun 2005 12:16:56 +0000

This is a tremendous tool to evaluate shades for indirect, direct, and bleaching shades. It is quick and easy. Worthy of a look at the next dental meeting or on the web at www.vident.com. Just under $4000.