CLINICAL LIFE

FALL 2022

™

INNOVATIVE SOLUTIONS | LEADING EDUCATION | CLINICAL EXCELLENCE

Before

Feature Article Feature Article

BEFORE

The Missing Tooth

5 on 5

Vargas, How theMarcos General Dentist and a BDB, DDS, MS Multidisciplinary Approach Can Achieve an Excellent Clinical Outcome Bob Margeas, DDS Danièle Larose, DMD, AAACD

Which Endo File is Right for Me? by Mr. Brian Bevan, Endodontic Product Manager

5 Clinical Must-Haves From 5 Restorative Educators

4 12

14 Utilizing a Soft Tissue Diode Laser for a Direct Resin Restoration by Troy Schmedding, DDS, AAACD

19

Ultradent™ Favourites from 7 CRD Specialists Featuring the CRD Team

20

IN THIS ISSUE Fall 2022

4

Strong. Simple. Beautiful.

Feature Article The Missing Tooth How the General Dentist and a Multidisciplinary Approach Can Achieve an Excellent Clinical Outcome - By Danièle Larose, DMD, AAACD

FIG. 13

Post-operative retracted close-up view (1:1) of the #6-#11.

8

The Evanesce system rivals the esthetics of porcelain restorations and mimics the beauty of natural tooth structure.

12

CLINICAL LIFE™ Promotions Select product offers for favourites and best sellers

Product Spotlight Which Endo File is Right for Me? - By Mr. Brian Bevan, Endodontic Product Manager

- David Chan, DMD, AAACD

14

Simple or complex. Single shade or layering technique, anterior or posterior. Whatever your technique or indication, Evanesce™ Universal Restorative is designed for truly natural, life-like esthetics. •

•

•

5 on 5 Clinical Must-Haves from 5 Restorative Educators

Message

Clinical Life™ magazine is designed to provide the Canadian dental community with a comprehensive guide to the very best clinical outcomes. In each issue, we include clinical articles written by many of today’s leading and sought-after key opinion leaders (KOLs). We seek articles that focus on clinically proven materials and techniques so you can make informed choices and provide your patients with outstanding results. Clinical Life™ magazine is just one part of our wide range of education opportunities. We love to get clinical and ensure our territory sales consultants add value to your practice – it is the CRD difference! I also encourage you to consider attending one of our many CE events held across Canada, or consider taking a HandsOnLine LIVE™ program from the comfort of your office. If you are looking for the pinnacle of Continuing Education programs, join us in Aruba Feb 3-5, 2023. In Aruba, you will have the unique experience of learning from six top KOLs over 12 hours of programs. Meet and speak to our educators along with 150 colleagues from all across North America in a relaxed, beautiful atmosphere. You can find out more about the Aruba Dental Conference by visiting arubadentalconference.com. I hope to meet you in Aruba! With limited attendance you need to act quickly to secure your spot.

- By Clinician's Choice®

16

Evanesce nano-hybrid composite’s non-sticky formulation makes it easy to manipulate and highly adaptable. Once placed, Evanesce can be sculpted without slumping to save on finishing time. Available in 22 VITA shades plus 3 bleaching shades, in 3 opacities, Evanesce polishes to an ultra-high, long-term shine in seconds. High strength Evanesce is 82% filled and boasts a high compressive strength, low wear, and low shrinkage to give you confidence for both anterior and posterior restorations.

Product Spotlight

CEO’s

20

Clinical Excellence Bioclear™ Matrix Choices for 2023

Peter G. Jordan - CEO pjordan_clinicianschoice

- By David Clark, DDS

Product Spotlight 7 on 7 Ultradent™ Favourites from 7 CRD Specialists - Featuring the CRD Team

1 on 1 with

Dr. Chan

Aruba is THIS beautiful in February

Dentistry and photography courtesy of David Chan, DMD, AAACD

22

Product Spotlight The Next Generation in Composite Warming Technology - by Marc Geissberger, DDS, MA, CPT

1-800-265-3444 CLINICALRESEARCHDENTAL.COM © Clinician’s Choice Dental Products, Inc. 2022. All rights reserved.

E x c l u s i ve E x c l u s i ve Distributor Distributor

26

New Product Showcase

Banff Canadian Rockies Dental Conference 2022

Peter Jordan, CEO, Clinical Research Denta l at the Aruba Dental Conference

Learn more about new products and resources clinicalresearchdental

@clinicalresearchdental

Morning lectures at the Aruba Dental Conference

Clinical Research Dental

IN THIS ISSUE Fall 2022

4

Strong. Simple. Beautiful.

Feature Article The Missing Tooth How the General Dentist and a Multidisciplinary Approach Can Achieve an Excellent Clinical Outcome - By Danièle Larose, DMD, AAACD

FIG. 13

Post-operative retracted close-up view (1:1) of the #6-#11.

8

The Evanesce system rivals the esthetics of porcelain restorations and mimics the beauty of natural tooth structure.

12

CLINICAL LIFE™ Promotions Select product offers for favourites and best sellers

Product Spotlight Which Endo File is Right for Me? - By Mr. Brian Bevan, Endodontic Product Manager

- David Chan, DMD, AAACD

14

Simple or complex. Single shade or layering technique, anterior or posterior. Whatever your technique or indication, Evanesce™ Universal Restorative is designed for truly natural, life-like esthetics. •

•

•

5 on 5 Clinical Must-Haves from 5 Restorative Educators

Message

Clinical Life™ magazine is designed to provide the Canadian dental community with a comprehensive guide to the very best clinical outcomes. In each issue, we include clinical articles written by many of today’s leading and sought-after key opinion leaders (KOLs). We seek articles that focus on clinically proven materials and techniques so you can make informed choices and provide your patients with outstanding results. Clinical Life™ magazine is just one part of our wide range of education opportunities. We love to get clinical and ensure our territory sales consultants add value to your practice – it is the CRD difference! I also encourage you to consider attending one of our many CE events held across Canada, or consider taking a HandsOnLine LIVE™ program from the comfort of your office. If you are looking for the pinnacle of Continuing Education programs, join us in Aruba Feb 3-5, 2023. In Aruba, you will have the unique experience of learning from six top KOLs over 12 hours of programs. Meet and speak to our educators along with 150 colleagues from all across North America in a relaxed, beautiful atmosphere. You can find out more about the Aruba Dental Conference by visiting arubadentalconference.com. I hope to meet you in Aruba! With limited attendance you need to act quickly to secure your spot.

- By Clinician's Choice®

16

Evanesce nano-hybrid composite’s non-sticky formulation makes it easy to manipulate and highly adaptable. Once placed, Evanesce can be sculpted without slumping to save on finishing time. Available in 22 VITA shades plus 3 bleaching shades, in 3 opacities, Evanesce polishes to an ultra-high, long-term shine in seconds. High strength Evanesce is 82% filled and boasts a high compressive strength, low wear, and low shrinkage to give you confidence for both anterior and posterior restorations.

Product Spotlight

CEO’s

20

Clinical Excellence Bioclear™ Matrix Choices for 2023

Peter G. Jordan - CEO pjordan_clinicianschoice

- By David Clark, DDS

Product Spotlight 7 on 7 Ultradent™ Favourites from 7 CRD Specialists - Featuring the CRD Team

1 on 1 with

Dr. Chan

Aruba is THIS beautiful in February

Dentistry and photography courtesy of David Chan, DMD, AAACD

22

Product Spotlight The Next Generation in Composite Warming Technology - by Marc Geissberger, DDS, MA, CPT

1-800-265-3444 CLINICALRESEARCHDENTAL.COM © Clinician’s Choice Dental Products, Inc. 2022. All rights reserved.

E x c l u s i ve E x c l u s i ve Distributor Distributor

26

New Product Showcase

Banff Canadian Rockies Dental Conference 2022

Peter Jordan, CEO, Clinical Research Denta l at the Aruba Dental Conference

Learn more about new products and resources clinicalresearchdental

@clinicalresearchdental

Morning lectures at the Aruba Dental Conference

Clinical Research Dental

FEATURE

CLINICAL EXCELLENCE

The Missing Tooth How the General Dentist and a Multidisciplinary Approach Can Achieve an Excellent Clinical Outcome

T

ABSTRACT

Danièle Larose

DMD, AAACD

Based in St-Laurent, Québec, Canada, Dr. Danièle Larose’s private practice focuses on conservative cosmetic and reconstructive dentistry. Years of daily practice have enabled her to develop her “how did you do that? — instant orthodontics” and “smile lift” techniques. Dr. Larose graduated from the University of Montreal in 1997. She attended the Dawson Institute and the Las Vegas Institute for Advanced Dental Training. For the past several years she has been receiving great reviews teaching full-day hands-on classes in Canada and the U.S. devoted to anterior aesthetic techniques. She is a member of the LVI Study Club, Implantology Study Club, AACD, CAED, Invisalign Study Club, and Ordre des dentistes du Québec.

Republished with permission, Journal of Cosmetic Dentistry, ©2022 American Academy of Cosmetic Dentistry, All Rights Reserved. 608.222.8583; www.aacd.com

he successful replacement of a single anterior tooth involves a balance between esthetics, function, and anticipated longevity. In many cases, collaboration between the general dentist and one or more specialists is required to resolve the hard and soft tissue challenges that may arise in the process of achieving the desired outcome. This article describes how a collaborative approach between a cosmetic dentist and a specialist in replacing a single tooth produced the maximum benefit for the patient. Also discussed are how committing to a thorough examination and an educated patient improved the patient’s overall dental health and self-esteem.

INTRODUCTION There are many options available today for patients presenting with a missing or failing tooth. While it can be a challenge to create a lifelike restoration that blends into the natural dentition, recontouring or augmenting the soft tissue can be very helpful in achieving natural esthetics. In addition to soft tissue esthetic procedures, correcting proportions with conservative orthodontic movements can greatly help patients through the unfortunate situation of anterior tooth loss.

CASE REPORT: PATIENT COMPLAINT AND HISTORY A 30-year-old male presented with a chief complaint that several teeth were sensitive to cold. He also wanted information on how to correct the crowding of his lower teeth and whiten his smile. He had not been to a dentist for at least five years and thought he had never had a dental cleaning. The patient had experienced a traumatic dental injury many years earlier and had been treated with an endodontic post and crown on tooth #10. (FIG. 1-2)

FIG. 1

Pre-operative retracted maxillary anterior frontal view (1:1).

4

| Fall 2022 |

a long-term and fixed solution and seemed to be more inclined toward the implant option after his orthodontic treatment. Consultation with a periodontist was recommended regarding the possibility of utilizing an implant to replace #10 and to evaluate the bone loss associated with #18. Possible tissue changes after extraction were outlined, and it was suggested that a connective tissue augmentation graft, performed by the periodontist, might be preferable to achieve optimal esthetics regardless of whether the patient chose a bridge or implant.5 Home whitening and clear aligners: The treatment plan included the use of clear aligners with a pontic in the area of #10 in lieu of a temporary partial denture, until the implant was ready to be restored. It was suggested that the aligners could also be used to whiten the teeth with a home whitening kit. The patient was informed that following orthodontics, esthetic correction of the anatomical defect on #7 might be possible with the use of composite or a minimal-preparation porcelain veneer. The patient received a written list of the estimated costs of the different treatment possibilities. He wanted to take some time to consider the options and to seek financial assistance before starting treatment.

FIG. 2

Pre-operative frontal smile view (1:2).

CLINICAL FINDINGS AND DIAGNOSIS A thorough hard and soft tissue examination was performed, including radiographs and clinical photographs. Periodontally, the patient presented with Class III calculus, several areas of recession, and a thin area of attached gingiva associated with the mandibular bicuspids and canines. In addition, periodontal bone loss was observed radiographically on the distal of tooth #18. A 6-mm clinical probing depth was noted in this area, likely due to an unerupted wisdom tooth. A 4-mm pocket with bone loss associated with #10 also was observed. A root fracture linked to a defective post and crown restoration on that tooth was suspected, as the pocket was clearly observed in one specific area. Several posterior interproximal carious lesions, including one of considerable size on #18, were identified, and treatment with composite restorations was recommended to the patient. An anatomical defect was present on the distal aspect of tooth #7. The patient had Class I occlusion with lower anterior crowding with working interferences present on teeth #4 and #5. The temporomandibular joints appeared healthy and asymptomatic. Apart from the dental issues, the patient was in excellent general health.

TREATMENT PLAN The patient was advised that treatment of the existing carious lesions and periodontal issues should be completed prior to orthodontic correction of the anterior crowding. The extraction of #17 was critical to the restoration of #18; however, treatment of #18 was planned to be deferred until its periodontal condition improved. A deep cleaning was recommended to remove supragingival and subgingival calculus and ensure tissue health. Orthodontics and implant placement: The risk of keeping the failing lateral incisor was discussed with the patient, as were options to replace it in the future. An endosseous implant, a Maryland bridge, and a removable partial denture were discussed as possibilities for the replacement of #10. Due to a size discrepancy resulting from the narrow widths of both lateral incisors, orthodontic treatment prior to the implant surgery would also create more ideal spacing for the implant in addition to correcting the crowding issues.1-4 The patient preferred

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

TREATMENT Treatment commenced with the administration of local anesthesia, caries removal, and the placement of composite restorations on #2, #4, and #5, which had been diagnosed at the comprehensive exam. The patient returned six months later with the post on #10 decemented. A root fracture was visible both clinically and radiographically. (FIG. 3) The prognosis was deemed poor and options for the replacement of this tooth were once again discussed. The patient required more time to secure finances to proceed with the more permanent solution. He also wished to consult with FIG. 3 the periodontist that we had recommended for implant placement. Pre-operative radiograph The post and crown were temporarily showing failing #10. recemented and the patient was again given a written estimate of all treatment options. He was reminded that #18 required restoration due to caries, but declined treatment until after his periodontal consultation. Orthodontics: The patient was scanned (iTero, Align Technology) and full photographic series (both orthodontic and AACD Accreditation) were obtained, followed by a thorough orthodontic examination. The latter revealed a Class I molar and canine occlusion, 20% overbite, and a 2-mm overjet. Lower anterior crowding was present, as were narrow arches and thinning attached gingiva in the areas of #22 and #27. The patient was informed that grafts might be necessary following orthodontic treatment, as well as the necessity of extracting #17 in order to restore #18 due to deep distal caries prior to starting orthodontic movements.

of caries. The patient proceeded with extraction of the semi-impacted wisdom tooth and, being eager to start orthodontic treatment, accepted accelerated orthodontics with a chairside accelerator (Propel Excellerator, Propel Orthodontics). Due to the quicker timeline, the ClinCheck was reviewed and modified, resulting in a treatment plan that included clear aligners (Invisalign, Align) plus retention in passive aligners. Aligners and home whitening: After approximately one month of healing post-extraction, #18 was restored. At the same appointment, clear aligner attachments were placed with clear composite (Evanesce Enamel Clear, Clinician’s Choice). Soft tissue infiltration was performed employing four carpules of injectable anesthesia (3% Citanest Plain, Dentsply Sirona) followed by micro-osteoperforations from distal of first bicuspids to distal of first bicuspids, upper and lower. A new Propel tip (using an implant driver at 45 RPM) was inserted to a depth of approximately 2mm into the cortical bone in all areas. At this point, the patient began the fivemonth, five-day aligner change orthodontic movements (this is in contrast to the 14-day wear of each set of clear aligners usually prescribed). The patient also began a whitening regimen with 10% carbide peroxide gel (Opalescence, Ultradent) nightly for two weeks. Implant placement: After consulting with the maxillofacial surgeon, the patient chose the implant option to replace #10. Extraction of #10 and immediate implant placement were planned during the final weeks of orthodontic treatment. This portion of treatment was timed to occur while the patient was in retention with aligner #23. Once the orthodontic movements were completed, limited occlusal equilibration was required as only the canines and one bicuspid needed an occlusal adjustment. A new scan was taken, and new custom trays were fabricated to be worn during orthodontic retention and the healing phase of the implant treatment. The periodontist extracted the failing #10, immediately placed a 4/3 x 15 mm endosseous implant (Biomet 3i), and performed a soft tissue augmentation procedure to achieve maximum gingival esthetics.6 With the healing cap in place, the clear aligners were fitted with a custom pontic to replace the extracted #10 for three to four months. Once the periodontist confirmed implant integration, impressions were taken to create a temporary crown on the implant. The surgeon then refined the soft tissue augmentation and the temporary crown was modified to ensure optimal esthetics (FIG. 4-5b). 5,7

FIG. 4

Initial temporary restoration on implant.

Three goals for orthodontic treatment were identified: correction of crowding, widening of both arches, and creation of equal spaces to enable #7 and #10 to be the same width. These orthodontic treatment objectives were planned using a 3D digital system that includes a Bolton analysis tool (ClinCheck, Align). Treatment time was estimated to be 10 months. The patient was given a consent form to take home for further review, as well as a prescription for a cephalometric radiograph. After several months, the patient returned and received a referral to a maxillofacial surgeon concerning the extraction of #17. The possibility of endodontic treatment on #18 was also discussed due to the progression

FIG. 5A

FIG. 5B

Initial temporary restoration.

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

5

FEATURE

CLINICAL EXCELLENCE

The Missing Tooth How the General Dentist and a Multidisciplinary Approach Can Achieve an Excellent Clinical Outcome

T

ABSTRACT

Danièle Larose

DMD, AAACD

Based in St-Laurent, Québec, Canada, Dr. Danièle Larose’s private practice focuses on conservative cosmetic and reconstructive dentistry. Years of daily practice have enabled her to develop her “how did you do that? — instant orthodontics” and “smile lift” techniques. Dr. Larose graduated from the University of Montreal in 1997. She attended the Dawson Institute and the Las Vegas Institute for Advanced Dental Training. For the past several years she has been receiving great reviews teaching full-day hands-on classes in Canada and the U.S. devoted to anterior aesthetic techniques. She is a member of the LVI Study Club, Implantology Study Club, AACD, CAED, Invisalign Study Club, and Ordre des dentistes du Québec.

Republished with permission, Journal of Cosmetic Dentistry, ©2022 American Academy of Cosmetic Dentistry, All Rights Reserved. 608.222.8583; www.aacd.com

he successful replacement of a single anterior tooth involves a balance between esthetics, function, and anticipated longevity. In many cases, collaboration between the general dentist and one or more specialists is required to resolve the hard and soft tissue challenges that may arise in the process of achieving the desired outcome. This article describes how a collaborative approach between a cosmetic dentist and a specialist in replacing a single tooth produced the maximum benefit for the patient. Also discussed are how committing to a thorough examination and an educated patient improved the patient’s overall dental health and self-esteem.

INTRODUCTION There are many options available today for patients presenting with a missing or failing tooth. While it can be a challenge to create a lifelike restoration that blends into the natural dentition, recontouring or augmenting the soft tissue can be very helpful in achieving natural esthetics. In addition to soft tissue esthetic procedures, correcting proportions with conservative orthodontic movements can greatly help patients through the unfortunate situation of anterior tooth loss.

CASE REPORT: PATIENT COMPLAINT AND HISTORY A 30-year-old male presented with a chief complaint that several teeth were sensitive to cold. He also wanted information on how to correct the crowding of his lower teeth and whiten his smile. He had not been to a dentist for at least five years and thought he had never had a dental cleaning. The patient had experienced a traumatic dental injury many years earlier and had been treated with an endodontic post and crown on tooth #10. (FIG. 1-2)

FIG. 1

Pre-operative retracted maxillary anterior frontal view (1:1).

4

| Fall 2022 |

a long-term and fixed solution and seemed to be more inclined toward the implant option after his orthodontic treatment. Consultation with a periodontist was recommended regarding the possibility of utilizing an implant to replace #10 and to evaluate the bone loss associated with #18. Possible tissue changes after extraction were outlined, and it was suggested that a connective tissue augmentation graft, performed by the periodontist, might be preferable to achieve optimal esthetics regardless of whether the patient chose a bridge or implant.5 Home whitening and clear aligners: The treatment plan included the use of clear aligners with a pontic in the area of #10 in lieu of a temporary partial denture, until the implant was ready to be restored. It was suggested that the aligners could also be used to whiten the teeth with a home whitening kit. The patient was informed that following orthodontics, esthetic correction of the anatomical defect on #7 might be possible with the use of composite or a minimal-preparation porcelain veneer. The patient received a written list of the estimated costs of the different treatment possibilities. He wanted to take some time to consider the options and to seek financial assistance before starting treatment.

FIG. 2

Pre-operative frontal smile view (1:2).

CLINICAL FINDINGS AND DIAGNOSIS A thorough hard and soft tissue examination was performed, including radiographs and clinical photographs. Periodontally, the patient presented with Class III calculus, several areas of recession, and a thin area of attached gingiva associated with the mandibular bicuspids and canines. In addition, periodontal bone loss was observed radiographically on the distal of tooth #18. A 6-mm clinical probing depth was noted in this area, likely due to an unerupted wisdom tooth. A 4-mm pocket with bone loss associated with #10 also was observed. A root fracture linked to a defective post and crown restoration on that tooth was suspected, as the pocket was clearly observed in one specific area. Several posterior interproximal carious lesions, including one of considerable size on #18, were identified, and treatment with composite restorations was recommended to the patient. An anatomical defect was present on the distal aspect of tooth #7. The patient had Class I occlusion with lower anterior crowding with working interferences present on teeth #4 and #5. The temporomandibular joints appeared healthy and asymptomatic. Apart from the dental issues, the patient was in excellent general health.

TREATMENT PLAN The patient was advised that treatment of the existing carious lesions and periodontal issues should be completed prior to orthodontic correction of the anterior crowding. The extraction of #17 was critical to the restoration of #18; however, treatment of #18 was planned to be deferred until its periodontal condition improved. A deep cleaning was recommended to remove supragingival and subgingival calculus and ensure tissue health. Orthodontics and implant placement: The risk of keeping the failing lateral incisor was discussed with the patient, as were options to replace it in the future. An endosseous implant, a Maryland bridge, and a removable partial denture were discussed as possibilities for the replacement of #10. Due to a size discrepancy resulting from the narrow widths of both lateral incisors, orthodontic treatment prior to the implant surgery would also create more ideal spacing for the implant in addition to correcting the crowding issues.1-4 The patient preferred

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

TREATMENT Treatment commenced with the administration of local anesthesia, caries removal, and the placement of composite restorations on #2, #4, and #5, which had been diagnosed at the comprehensive exam. The patient returned six months later with the post on #10 decemented. A root fracture was visible both clinically and radiographically. (FIG. 3) The prognosis was deemed poor and options for the replacement of this tooth were once again discussed. The patient required more time to secure finances to proceed with the more permanent solution. He also wished to consult with FIG. 3 the periodontist that we had recommended for implant placement. Pre-operative radiograph The post and crown were temporarily showing failing #10. recemented and the patient was again given a written estimate of all treatment options. He was reminded that #18 required restoration due to caries, but declined treatment until after his periodontal consultation. Orthodontics: The patient was scanned (iTero, Align Technology) and full photographic series (both orthodontic and AACD Accreditation) were obtained, followed by a thorough orthodontic examination. The latter revealed a Class I molar and canine occlusion, 20% overbite, and a 2-mm overjet. Lower anterior crowding was present, as were narrow arches and thinning attached gingiva in the areas of #22 and #27. The patient was informed that grafts might be necessary following orthodontic treatment, as well as the necessity of extracting #17 in order to restore #18 due to deep distal caries prior to starting orthodontic movements.

of caries. The patient proceeded with extraction of the semi-impacted wisdom tooth and, being eager to start orthodontic treatment, accepted accelerated orthodontics with a chairside accelerator (Propel Excellerator, Propel Orthodontics). Due to the quicker timeline, the ClinCheck was reviewed and modified, resulting in a treatment plan that included clear aligners (Invisalign, Align) plus retention in passive aligners. Aligners and home whitening: After approximately one month of healing post-extraction, #18 was restored. At the same appointment, clear aligner attachments were placed with clear composite (Evanesce Enamel Clear, Clinician’s Choice). Soft tissue infiltration was performed employing four carpules of injectable anesthesia (3% Citanest Plain, Dentsply Sirona) followed by micro-osteoperforations from distal of first bicuspids to distal of first bicuspids, upper and lower. A new Propel tip (using an implant driver at 45 RPM) was inserted to a depth of approximately 2mm into the cortical bone in all areas. At this point, the patient began the fivemonth, five-day aligner change orthodontic movements (this is in contrast to the 14-day wear of each set of clear aligners usually prescribed). The patient also began a whitening regimen with 10% carbide peroxide gel (Opalescence, Ultradent) nightly for two weeks. Implant placement: After consulting with the maxillofacial surgeon, the patient chose the implant option to replace #10. Extraction of #10 and immediate implant placement were planned during the final weeks of orthodontic treatment. This portion of treatment was timed to occur while the patient was in retention with aligner #23. Once the orthodontic movements were completed, limited occlusal equilibration was required as only the canines and one bicuspid needed an occlusal adjustment. A new scan was taken, and new custom trays were fabricated to be worn during orthodontic retention and the healing phase of the implant treatment. The periodontist extracted the failing #10, immediately placed a 4/3 x 15 mm endosseous implant (Biomet 3i), and performed a soft tissue augmentation procedure to achieve maximum gingival esthetics.6 With the healing cap in place, the clear aligners were fitted with a custom pontic to replace the extracted #10 for three to four months. Once the periodontist confirmed implant integration, impressions were taken to create a temporary crown on the implant. The surgeon then refined the soft tissue augmentation and the temporary crown was modified to ensure optimal esthetics (FIG. 4-5b). 5,7

FIG. 4

Initial temporary restoration on implant.

Three goals for orthodontic treatment were identified: correction of crowding, widening of both arches, and creation of equal spaces to enable #7 and #10 to be the same width. These orthodontic treatment objectives were planned using a 3D digital system that includes a Bolton analysis tool (ClinCheck, Align). Treatment time was estimated to be 10 months. The patient was given a consent form to take home for further review, as well as a prescription for a cephalometric radiograph. After several months, the patient returned and received a referral to a maxillofacial surgeon concerning the extraction of #17. The possibility of endodontic treatment on #18 was also discussed due to the progression

FIG. 5A

FIG. 5B

Initial temporary restoration.

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

5

FEATURE

CLINICAL EXCELLENCE

The healing time for the temporary crown was six months, during which time the patient was instructed to wear his aligners nightly. Once tissue healing was achieved (FIG. 6), the temporary crown was removed, and an implant transfer was placed and verified with a periapical radiograph. (FIG. 7) A final impression was taken with polyvinyl siloxane

FIG. 6

Tissue shaping with temporary restoration on implant.

impression material (Affinity, Clinician’s Choice). The final shade selection, multiple photographs for the technician, and a bite registration were also obtained at this time. (FIG. 8) The temporary crown was then re-cemented. An impression of the temporary crown was also sent to the laboratory to communicate the emergence profile to be replicated. Final restoration: After consultation with the technician, the preferred definitive restoration was determined to be a custom zirconia implant abutment (FIG. 9) with a

cemented crown (e.max, Ivoclar Vivadent). In consideration of the periodontist, it was decided to use temporary cement to ensure easier removal of the crown if it became necessary in the future. Within a few weeks, the new abutment and crown were ready for a try-in. Shape and shade modifications were required, so the case was returned to the lab along with specific instructions and photographs. The temporary crown was once again recemented. Once the prescribed modifications were completed, a second try-in resulted in much-improved esthetics, to the satisfaction of both patient and doctor. It was decided to place the abutment permanently and torque to 20 Ncm. Polytetrafluoroethylene tape was placed in the access cavity and composite (B1 Evanesce, Clinician’s Choice) was used to close the opening in the abutment. The crown was cemented (TempBond, Kerr Dental). A radiograph was taken to ensure no subgingival cement was present. (FIG. 10) (Note: in smile design, it is ideal that the two centrals be identical. On the other hand, it is normal and visually pleasing for the two laterals to be slightly different.) That said, the defect on #7 was now visually displeasing to the patient and he agreed to a slight shape modification using composite to better match #10. (FIG. 11)

FIG. 15

FIG. 12

Post-operative close-up retracted right lateral view (1:1) of #5-#9, showing corrected defect on #7 with the use of composite resin.

Post-operative full-face portrait view.

ACKNOWLEDGMENT

FOLLOW-UP

FIG. 10

Final periapical X-ray of #10 after completion of treatment.

FIG. 7

Periapical view of temporary crown on implant.

The patient returned at two months and six months for overall assessment. The periodontist also saw him for a follow-up and was very happy with the results. Most importantly, the patient was pain-free and very pleased with the restorative outcome and overall treatment experience. (FIG. 13-15)

The author thanks periodontist Dr. Alexandre Taché (Pointe-Clair, QC, Canada), for his clinical work with the case discussed in this article; and Mark Willes, CDT (Experience Dental Studio; Lindon, UT), for his assistance and skill with the case.

SUMMARY

REFERENCES

Employing a multidisciplinary approach combining orthodontics, periodontal, and restorative solutions to help ensure complete harmony of the smile instead of focusing on a single tooth can offer our patients an optimal esthetic outcome. This is true not only for the missing tooth challenge but in restorative cases as well. The use of clear aligners has improved the esthetics and longevity of the author’s patients’ restorations. Adding orthodontics in the general dental practice is an excellent asset to enhance patient outcomes.

2. Carnio J, Carnio AT. Papilla reconstruction: interdisciplinary consideration for clinical success. J Esthet Restor Dent. 2018 Nov;30(6):484-91.

1. Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, Cattaneo V. Morphometric study of the inter proximal unit in the aesthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol. 2007 Dec;78(12):2260-5.

3. Bello A, Jarvis RH. A review of aesthetic alternatives for the restoration of anterior teeth. J Prosthet Dent. 1997 Nov;78(5):437-40. 4. Pini NP, de-Marchi LM, Gribel BF, Ubaldini ALM, Pascotto RC. Analysis of the golden proportion and width/height ratios of maxillary anterior dentition in patients with lateral incisor agenesis. J Esthet Restor Dent. 2012 Dec;24(6):402-14. 5. Pini NP, de-Marchi LM, Gribel BF, Pascotto RC. Digital analysis of anterior dental aesthetic parameters in patients with bilateral maxillary lateral incisor agenesis. J Esthet Restor Dent. 2013 Jun;25(3):189-200. 6. Yu SH, Tseng SC, Wang HL. Classification of soft tissue grafting materials based on biologic principles. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):849-54. 7. Eghbali A, Seyssens L, de Bruykere T, Younes F, Cleymaet R, Cosyn J. A 5-year prospective study on the clinical and aesthetic outcomes of alveolar ridge preservation and connective tissue graft at the buccal aspect of single implants. J Clin Periodontol. 2018 Dec;45(12):1475-84.

FIG. 11

Close-up retracted right lateral view (1:1) showing a defect on the distal of #7.

FIG. 13

Post-operative retracted close-up view (1:1) of the #6-#11.

FIG. 8

Shade guide with many samples to help the technician evaluate the shading to be achieved.

No preparation was made; however, the biofilm was removed with a blaster (Bioclear). Tooth #12 was then etched and a single coat of adhesive (MPa Max, Clinician’s Choice) was applied. The tooth was restored employing a combination of nano-enhanced universal restorative composite (Universal, Evanesce, Clinician’s Choice), white opaquer and grey tint (Creative Color, Cosmedent), and a thin layer of Evanesce Enamel Clear (Clinician’s Choice). After light curing, the restoration was shaped and polished with a medium disc (SofLex, 3M) and polishers (A.S.A.P., Clinician’s Choice). (FIG. 12) The patient was scanned for his final retention trays (Vivera, Align). After two weeks he returned for the tray insertion. He was instructed to wear his retainers nightly for at least two years, then two to three times a week.

FIG. 14

Post-operative frontal smile view (1:2). FIG. 9

Zirconia abutment on soft tissue model.

6

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

7

FEATURE

CLINICAL EXCELLENCE

The healing time for the temporary crown was six months, during which time the patient was instructed to wear his aligners nightly. Once tissue healing was achieved (FIG. 6), the temporary crown was removed, and an implant transfer was placed and verified with a periapical radiograph. (FIG. 7) A final impression was taken with polyvinyl siloxane

FIG. 6

Tissue shaping with temporary restoration on implant.

impression material (Affinity, Clinician’s Choice). The final shade selection, multiple photographs for the technician, and a bite registration were also obtained at this time. (FIG. 8) The temporary crown was then re-cemented. An impression of the temporary crown was also sent to the laboratory to communicate the emergence profile to be replicated. Final restoration: After consultation with the technician, the preferred definitive restoration was determined to be a custom zirconia implant abutment (FIG. 9) with a

cemented crown (e.max, Ivoclar Vivadent). In consideration of the periodontist, it was decided to use temporary cement to ensure easier removal of the crown if it became necessary in the future. Within a few weeks, the new abutment and crown were ready for a try-in. Shape and shade modifications were required, so the case was returned to the lab along with specific instructions and photographs. The temporary crown was once again recemented. Once the prescribed modifications were completed, a second try-in resulted in much-improved esthetics, to the satisfaction of both patient and doctor. It was decided to place the abutment permanently and torque to 20 Ncm. Polytetrafluoroethylene tape was placed in the access cavity and composite (B1 Evanesce, Clinician’s Choice) was used to close the opening in the abutment. The crown was cemented (TempBond, Kerr Dental). A radiograph was taken to ensure no subgingival cement was present. (FIG. 10) (Note: in smile design, it is ideal that the two centrals be identical. On the other hand, it is normal and visually pleasing for the two laterals to be slightly different.) That said, the defect on #7 was now visually displeasing to the patient and he agreed to a slight shape modification using composite to better match #10. (FIG. 11)

FIG. 15

FIG. 12

Post-operative close-up retracted right lateral view (1:1) of #5-#9, showing corrected defect on #7 with the use of composite resin.

Post-operative full-face portrait view.

ACKNOWLEDGMENT

FOLLOW-UP

FIG. 10

Final periapical X-ray of #10 after completion of treatment.

FIG. 7

Periapical view of temporary crown on implant.

The patient returned at two months and six months for overall assessment. The periodontist also saw him for a follow-up and was very happy with the results. Most importantly, the patient was pain-free and very pleased with the restorative outcome and overall treatment experience. (FIG. 13-15)

The author thanks periodontist Dr. Alexandre Taché (Pointe-Clair, QC, Canada), for his clinical work with the case discussed in this article; and Mark Willes, CDT (Experience Dental Studio; Lindon, UT), for his assistance and skill with the case.

SUMMARY

REFERENCES

Employing a multidisciplinary approach combining orthodontics, periodontal, and restorative solutions to help ensure complete harmony of the smile instead of focusing on a single tooth can offer our patients an optimal esthetic outcome. This is true not only for the missing tooth challenge but in restorative cases as well. The use of clear aligners has improved the esthetics and longevity of the author’s patients’ restorations. Adding orthodontics in the general dental practice is an excellent asset to enhance patient outcomes.

2. Carnio J, Carnio AT. Papilla reconstruction: interdisciplinary consideration for clinical success. J Esthet Restor Dent. 2018 Nov;30(6):484-91.

1. Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, Cattaneo V. Morphometric study of the inter proximal unit in the aesthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol. 2007 Dec;78(12):2260-5.

3. Bello A, Jarvis RH. A review of aesthetic alternatives for the restoration of anterior teeth. J Prosthet Dent. 1997 Nov;78(5):437-40. 4. Pini NP, de-Marchi LM, Gribel BF, Ubaldini ALM, Pascotto RC. Analysis of the golden proportion and width/height ratios of maxillary anterior dentition in patients with lateral incisor agenesis. J Esthet Restor Dent. 2012 Dec;24(6):402-14. 5. Pini NP, de-Marchi LM, Gribel BF, Pascotto RC. Digital analysis of anterior dental aesthetic parameters in patients with bilateral maxillary lateral incisor agenesis. J Esthet Restor Dent. 2013 Jun;25(3):189-200. 6. Yu SH, Tseng SC, Wang HL. Classification of soft tissue grafting materials based on biologic principles. Int J Periodontics Restorative Dent. 2018 Nov/Dec;38(6):849-54. 7. Eghbali A, Seyssens L, de Bruykere T, Younes F, Cleymaet R, Cosyn J. A 5-year prospective study on the clinical and aesthetic outcomes of alveolar ridge preservation and connective tissue graft at the buccal aspect of single implants. J Clin Periodontol. 2018 Dec;45(12):1475-84.

FIG. 11

Close-up retracted right lateral view (1:1) showing a defect on the distal of #7.

FIG. 13

Post-operative retracted close-up view (1:1) of the #6-#11.

FIG. 8

Shade guide with many samples to help the technician evaluate the shading to be achieved.

No preparation was made; however, the biofilm was removed with a blaster (Bioclear). Tooth #12 was then etched and a single coat of adhesive (MPa Max, Clinician’s Choice) was applied. The tooth was restored employing a combination of nano-enhanced universal restorative composite (Universal, Evanesce, Clinician’s Choice), white opaquer and grey tint (Creative Color, Cosmedent), and a thin layer of Evanesce Enamel Clear (Clinician’s Choice). After light curing, the restoration was shaped and polished with a medium disc (SofLex, 3M) and polishers (A.S.A.P., Clinician’s Choice). (FIG. 12) The patient was scanned for his final retention trays (Vivera, Align). After two weeks he returned for the tray insertion. He was instructed to wear his retainers nightly for at least two years, then two to three times a week.

FIG. 14

Post-operative frontal smile view (1:2). FIG. 9

Zirconia abutment on soft tissue model.

6

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

7

PROMOTIONS

INNOVATIVE SOLUTIONS

EVANESCE

™

UNIVERSAL RESTORATIVE COMPOSITE

MPa™ MAX

TINTS & OPAQUERS

MAXIMUM PERFORMANCE ADHESIVE

CREATIVE COLOR®

•

Tints

•

Simple or complex. Single shade or layering technique, anterior or posterior. Whatever your technique or indication, Evanesce™ Universal Restorative is designed for truly natural, life-like esthetics. Evanesce offers ideal, slump-free handling and beautiful shade matching to the VITA shade guide. Highly polishable for the ultimate in restorative esthetics.

• •

Formulation includes 0.2% chlorhexidine to improve bond longevity; inhibiting MMPs Designed with slightly thicker viscosity, allowing you to easily coat each adhesive wall while ensuring the dentin and enamel are properly sealed Consistently coats and seals dentin tubules which prevents intratubular fluid flow – the cause of post-operative pain Bond strength in excess of 45 MPa to dentin and enamel

Create incisal translucency and cervical chroma

Opaquers Helps you block unwanted colour and shine-through

Pink Opaque Quickly neutralize dark stains and metal

2

Evanesce™

Just SHADES

ENAMEL (80% Opacity) A1E

A2E

A3E

A3.5E

B0.5E

B1E

B2E

UNIVERSAL (85% Opacity) A1U

A2U

A3U

A3.5U

A4U

DENTIN (90% Opacity) A1D A2D

B0.5U

A3D

B1U

B2U

C1U

A3.5D

C2U

B1D

C3U

BL1U

Kit includes: 1 x 5mL bottle MPa MAX 1 x 5mL bottle G5 All-Purpose Desensitizer 1 x 5mL syringe Max Etch, Syringe tips, Applicator brushes, Mixing wells, Technique Guide & SDS

BL3U Before

C4D

After Dentistry courtesy of Dr. Marcos Vargas

Evanesce™ FX (Non-VITA) FX White (70% Opacity) Available Sizes

FX Incisal (60% Opacity)

0.3gm Single Dose

3gm Syringes

FX Clear (50% Opacity)

MPa MAX TECHNIQUE KIT

MPa MAX 5 mL BOTTLE

266901

266506

2.5 g SYRINGE

Shades: Opaquers (2.5 g) syringes of A1-B1-L0, A2-A2.5, A3, B2, C1-D2, C4, White, Pink

451403, 4515##

Shades: Tints (2.5 g) syringes of Honey Yellow, Grey, Violet, Light Brown, Dark Brown

4gm Syringes

™

™

OPALESCENCE™ PF

BIOCLEAR™ BLASTER

A.S.A.P.®

FLEXIDISC /FLEXIBUFF

TEETH WHITENING TREATMENT

PROPHY BLASTER

ALL SURFACE ACCESS POLISHERS

FINISHING & POLISHING DISCS

Ideal for patients who want to whiten while they undergo clear aligner treatment!

The Bioclear Blaster is the perfect combination of minimally invasive yet effective cleaning power, ergonomic design, easy installation, and adaptability. Using a powerful and effective prophy-blasting Aluminum Trihydroxide slurry, the Blaster efficiently removes the toughest biofilm without damaging the enamel surface.

•

FlexiDisc Finishing & Polishing Discs

• • • • • •

Custom take-home whitening treatment Whitening gel contains PF (potassium nitrate and fluoride) for sensitivity treatment and tooth health Formulated to prevent dehydration and shade relapse Sticky, viscous gel won’t migrate to soft tissues and ensures the stray stays securely in place 10% formula is recommended for use with clear aligners in a 8-hour wear time Opalescence PF is available in five treatments for easy treatment flexibility: 10%, 15%, 20%, 35%, 45%

• • •

Highly effective, minimally invasive biofilm removal Easy portability between operatories Sleek, efficient design that plugs directly into the water and air already plumbed into the operatory delivery system

•

•

The A.S.A.P. Pre-polisher (purple) is embedded with diamond particles (44 microns) and gently diminishes small surface defects without affecting anatomy, and prepares the surface for a final high gloss shine. The A.S.A.P. Final High Shine Polisher (peach) is embedded with small, 3-6 micron sized diamond particles to provide a life-like polish in as little as 20 seconds. Autoclavable up to 30 times, A.S.A.P. Polishers can withstand wear while providing an efficient and consistent polish use after use.

Thin and flexible aluminum oxide discs that give you more control and an unbeatable final polish.

FlexiBuff Dental Polishing Buff Felt-coated, highly flexible mylar disc used to apply polishing paste like Enamelize to put the final lustre on composite, porcelain, metal and natural tooth structure.

FLEXIDISC MINI ALLPURPOSE KIT 530900 Kit includes 600 discs with 2 mandrels Kit contains: 1 x 2 oz Dual Colour Disclosing Solution 1 x 6 oz Cavitron Blasting Powder 1 x KaVo Swivel Attachment 1 x Cleaning Wire

8

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Dentistry and photography courtesy of Danièle Larose, DMD, AAACD

ASSORTED STARTER PACK 130917

Assorted Starter Pack contains: 3 Pre-polishers (small), 3 Pre-polishers (large), 3 Final High Shine Polishers (small), 3 Final High Shine Polishers (large).

100-PACK REFILL FLEXIDISC 130912

SMALL 6-PACK 130913 LARGE 6-PACK 130912

100-PACK FLEXIBUFF 5341##

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

9

PROMOTIONS

INNOVATIVE SOLUTIONS

EVANESCE

™

UNIVERSAL RESTORATIVE COMPOSITE

MPa™ MAX

TINTS & OPAQUERS

MAXIMUM PERFORMANCE ADHESIVE

CREATIVE COLOR®

•

Tints

•

Simple or complex. Single shade or layering technique, anterior or posterior. Whatever your technique or indication, Evanesce™ Universal Restorative is designed for truly natural, life-like esthetics. Evanesce offers ideal, slump-free handling and beautiful shade matching to the VITA shade guide. Highly polishable for the ultimate in restorative esthetics.

• •

Formulation includes 0.2% chlorhexidine to improve bond longevity; inhibiting MMPs Designed with slightly thicker viscosity, allowing you to easily coat each adhesive wall while ensuring the dentin and enamel are properly sealed Consistently coats and seals dentin tubules which prevents intratubular fluid flow – the cause of post-operative pain Bond strength in excess of 45 MPa to dentin and enamel

Create incisal translucency and cervical chroma

Opaquers Helps you block unwanted colour and shine-through

Pink Opaque Quickly neutralize dark stains and metal

2

Evanesce™

Just SHADES

ENAMEL (80% Opacity) A1E

A2E

A3E

A3.5E

B0.5E

B1E

B2E

UNIVERSAL (85% Opacity) A1U

A2U

A3U

A3.5U

A4U

DENTIN (90% Opacity) A1D A2D

B0.5U

A3D

B1U

B2U

C1U

A3.5D

C2U

B1D

C3U

BL1U

Kit includes: 1 x 5mL bottle MPa MAX 1 x 5mL bottle G5 All-Purpose Desensitizer 1 x 5mL syringe Max Etch, Syringe tips, Applicator brushes, Mixing wells, Technique Guide & SDS

BL3U Before

C4D

After Dentistry courtesy of Dr. Marcos Vargas

Evanesce™ FX (Non-VITA) FX White (70% Opacity) Available Sizes

FX Incisal (60% Opacity)

0.3gm Single Dose

3gm Syringes

FX Clear (50% Opacity)

MPa MAX TECHNIQUE KIT

MPa MAX 5 mL BOTTLE

266901

266506

2.5 g SYRINGE

Shades: Opaquers (2.5 g) syringes of A1-B1-L0, A2-A2.5, A3, B2, C1-D2, C4, White, Pink

451403, 4515##

Shades: Tints (2.5 g) syringes of Honey Yellow, Grey, Violet, Light Brown, Dark Brown

4gm Syringes

™

™

OPALESCENCE™ PF

BIOCLEAR™ BLASTER

A.S.A.P.®

FLEXIDISC /FLEXIBUFF

TEETH WHITENING TREATMENT

PROPHY BLASTER

ALL SURFACE ACCESS POLISHERS

FINISHING & POLISHING DISCS

Ideal for patients who want to whiten while they undergo clear aligner treatment!

The Bioclear Blaster is the perfect combination of minimally invasive yet effective cleaning power, ergonomic design, easy installation, and adaptability. Using a powerful and effective prophy-blasting Aluminum Trihydroxide slurry, the Blaster efficiently removes the toughest biofilm without damaging the enamel surface.

•

FlexiDisc Finishing & Polishing Discs

• • • • • •

Custom take-home whitening treatment Whitening gel contains PF (potassium nitrate and fluoride) for sensitivity treatment and tooth health Formulated to prevent dehydration and shade relapse Sticky, viscous gel won’t migrate to soft tissues and ensures the stray stays securely in place 10% formula is recommended for use with clear aligners in a 8-hour wear time Opalescence PF is available in five treatments for easy treatment flexibility: 10%, 15%, 20%, 35%, 45%

• • •

Highly effective, minimally invasive biofilm removal Easy portability between operatories Sleek, efficient design that plugs directly into the water and air already plumbed into the operatory delivery system

•

•

The A.S.A.P. Pre-polisher (purple) is embedded with diamond particles (44 microns) and gently diminishes small surface defects without affecting anatomy, and prepares the surface for a final high gloss shine. The A.S.A.P. Final High Shine Polisher (peach) is embedded with small, 3-6 micron sized diamond particles to provide a life-like polish in as little as 20 seconds. Autoclavable up to 30 times, A.S.A.P. Polishers can withstand wear while providing an efficient and consistent polish use after use.

Thin and flexible aluminum oxide discs that give you more control and an unbeatable final polish.

FlexiBuff Dental Polishing Buff Felt-coated, highly flexible mylar disc used to apply polishing paste like Enamelize to put the final lustre on composite, porcelain, metal and natural tooth structure.

FLEXIDISC MINI ALLPURPOSE KIT 530900 Kit includes 600 discs with 2 mandrels Kit contains: 1 x 2 oz Dual Colour Disclosing Solution 1 x 6 oz Cavitron Blasting Powder 1 x KaVo Swivel Attachment 1 x Cleaning Wire

8

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Dentistry and photography courtesy of Danièle Larose, DMD, AAACD

ASSORTED STARTER PACK 130917

Assorted Starter Pack contains: 3 Pre-polishers (small), 3 Pre-polishers (large), 3 Final High Shine Polishers (small), 3 Final High Shine Polishers (large).

100-PACK REFILL FLEXIDISC 130912

SMALL 6-PACK 130913 LARGE 6-PACK 130912

100-PACK FLEXIBUFF 5341##

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

9

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

Efficient Post Core Fabrication

W

hile modern endodontics, including access design, conservative root canal shapes and better irrigation protocols have evolved significantly in the past 10 to 15 years, it is still acknowledged that the restorative continuum is a key factor in the long-term success of endodontically treated teeth.

Manfred Friedman BDS, BChD

Dr. Manfred Friedman graduated from the University of Witwatersrand Johannesburg in 1971 and then obtained his B.Ch.D. Honors at the University of Pretoria in 1980. He taught the undergrad Endodontic Lab course at Schulich School of Medicine and Dentistry at Western University from 1995 to 2021. Dr. Friedman has given numerous courses on Endodontics at the University of Western Ontario, with interests in rotary instrumentation, endodontic materials, Apex locators, and restoring the endodontically treated tooth.

When a post and core are part of the foundation of a permanent restoration, then certain fundamental modern principles MUST be observed, such as: • A post placement protocol that ensures maximum bond strengths and the best possible retention. • Preserving as much tooth structure as possible. • Respecting the existing radicular anatomy. • The ability to retreat the case predictably if necessary. • Choosing the right post and core materials. • A post should NOT weaken the tooth, it should possibly reduce the risk of fracture, not increase it1. Focusing on the post itself, modern pre-fabricated posts which are fiber-reinforced resin posts represent the standard of care in most cases. They are usually reinforced with eGlass or quartz fibers, and as a group, exhibit a favorable modulus of elasticity, almost equal to dentin. But not all posts are created equal, so the following are critical features to look for in a fiber post: • High radiopacity. • A tapered shape in keeping with canal shapes. • A pre-silanated, micro-retentive surface conducive to bonding. • High flexural strength.

FIG. 1

While I have used a few different posts in my practice, the one that ticks off all the boxes for me is the Macro-Lock XRO Illusion, from RTD. I have placed over 500 of them without a single failure. The gentle taper, close to a .04 is in keeping with modern canal shapes. The micro-retentive surface combined with macro-retentive spirals in the canal portion along with an anti-rotational core design give me confidence that a post placed 5-6mm into the canal is more than adequate to ensure excellent retention and maximum bond strength. At 1800 MPa, it has among the highest flexural strengths of any fiber post, and is the most radiopaque I have worked with. Another nice little feature is the illusion technology; the intrinsic translucent color disappears at body temperature when placed, but if re-treatment was necessary, all I have to do is expose the post in the core, spray a bit of cold water on, and the color reappears to show me where to drill out the post. While there are a variety of methods to cement these posts, I have always relied on a single bottle totaletch adhesive (MPa Max, Clinician’s Choice), with a dual-cure composite core material, such as Zircules (Clinician’s Choice) for maximum bond strength. Zircules is a superior material due to its hardness, making it effortless to trim, as well as its superior handling characteristics; it NEVER slumps, and I use it for both cementation and build-up.

1. Bitter, K, Noetzel, J, Stamm, O, Vaudt, J, Meyer-Lueckel, H, Neumann, K, Kielbassa, AM. Randomized clinical trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months. J Endod. 2009 Nov;35(11):1477-82. Epub 2009 Sep 18.

Etched coronal access and post space.

MPa Max applied to post space and access and air thinned.

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Learn more about Macro-Lock Illusion XRO

DUAL-CURE OR

SELF-CURE

Zircules™ surpasses other core materials in strength, handling, and cutting efficiency. Its chemistry maintains high strength, regardless of whether it’s used in a dual-cure or self-cure technique. With ideal flow consistency Zircules is stackable and cuts like dentin, eliminating the possibility of gouging for any core build-up, simple or complex. y

Once polymerized, it cuts beautifully, just like dentin.

y

Flows easily into the post space, yet it is stackable so that you can build a sufficient amount of core material without the material slumping.

y

Transition from core material to natural tooth is smooth and free from gouging.

y

Available in two esthetic shades (A2, A3), as well as White Opaque and Blue.

FIG. 3

Learn More FIG. 4

Post cemented in canal with Zircules and cured.

2. Dallari, A., Mason, P., Rovatti, L., Dallari, B. Effect of surface treatments on retention of quartz-fiber posts. J Dent Res. Vol 87 (Spec. Iss. C) Abstract #0383, PEF Division 2008 (www. dentalresearch.org).

• A non-aggressive matching post drill that removes as little tooth structure as possible.

| Fall 2022 |

FIG. 2

Core Material That Really Stacks Up

REFERENCES

• Some macro-retentive features, grooves or spirals, and anti-rotation design to enhance bonding success2.

10

Completed RCT with post space in palatal root.

Zircules 5 mL syringe

Zircules 25 mL cartridges

A2 406502 A3 406503 Blue 406504 WO 406501

A2 406922 A3 406923 Blue 406924 WO 406921

FIG. 5

Core incrementally built-up and cured.

Dentistry and photography courtesy of Christopher Ramsey, DMD © Clinician’s Choice Dental Products, Inc. 2022. All rights reserved.

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

Efficient Post Core Fabrication

W

hile modern endodontics, including access design, conservative root canal shapes and better irrigation protocols have evolved significantly in the past 10 to 15 years, it is still acknowledged that the restorative continuum is a key factor in the long-term success of endodontically treated teeth.

Manfred Friedman BDS, BChD

Dr. Manfred Friedman graduated from the University of Witwatersrand Johannesburg in 1971 and then obtained his B.Ch.D. Honors at the University of Pretoria in 1980. He taught the undergrad Endodontic Lab course at Schulich School of Medicine and Dentistry at Western University from 1995 to 2021. Dr. Friedman has given numerous courses on Endodontics at the University of Western Ontario, with interests in rotary instrumentation, endodontic materials, Apex locators, and restoring the endodontically treated tooth.

When a post and core are part of the foundation of a permanent restoration, then certain fundamental modern principles MUST be observed, such as: • A post placement protocol that ensures maximum bond strengths and the best possible retention. • Preserving as much tooth structure as possible. • Respecting the existing radicular anatomy. • The ability to retreat the case predictably if necessary. • Choosing the right post and core materials. • A post should NOT weaken the tooth, it should possibly reduce the risk of fracture, not increase it1. Focusing on the post itself, modern pre-fabricated posts which are fiber-reinforced resin posts represent the standard of care in most cases. They are usually reinforced with eGlass or quartz fibers, and as a group, exhibit a favorable modulus of elasticity, almost equal to dentin. But not all posts are created equal, so the following are critical features to look for in a fiber post: • High radiopacity. • A tapered shape in keeping with canal shapes. • A pre-silanated, micro-retentive surface conducive to bonding. • High flexural strength.

FIG. 1

While I have used a few different posts in my practice, the one that ticks off all the boxes for me is the Macro-Lock XRO Illusion, from RTD. I have placed over 500 of them without a single failure. The gentle taper, close to a .04 is in keeping with modern canal shapes. The micro-retentive surface combined with macro-retentive spirals in the canal portion along with an anti-rotational core design give me confidence that a post placed 5-6mm into the canal is more than adequate to ensure excellent retention and maximum bond strength. At 1800 MPa, it has among the highest flexural strengths of any fiber post, and is the most radiopaque I have worked with. Another nice little feature is the illusion technology; the intrinsic translucent color disappears at body temperature when placed, but if re-treatment was necessary, all I have to do is expose the post in the core, spray a bit of cold water on, and the color reappears to show me where to drill out the post. While there are a variety of methods to cement these posts, I have always relied on a single bottle totaletch adhesive (MPa Max, Clinician’s Choice), with a dual-cure composite core material, such as Zircules (Clinician’s Choice) for maximum bond strength. Zircules is a superior material due to its hardness, making it effortless to trim, as well as its superior handling characteristics; it NEVER slumps, and I use it for both cementation and build-up.

1. Bitter, K, Noetzel, J, Stamm, O, Vaudt, J, Meyer-Lueckel, H, Neumann, K, Kielbassa, AM. Randomized clinical trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months. J Endod. 2009 Nov;35(11):1477-82. Epub 2009 Sep 18.

Etched coronal access and post space.

MPa Max applied to post space and access and air thinned.

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Learn more about Macro-Lock Illusion XRO

DUAL-CURE OR

SELF-CURE

Zircules™ surpasses other core materials in strength, handling, and cutting efficiency. Its chemistry maintains high strength, regardless of whether it’s used in a dual-cure or self-cure technique. With ideal flow consistency Zircules is stackable and cuts like dentin, eliminating the possibility of gouging for any core build-up, simple or complex. y

Once polymerized, it cuts beautifully, just like dentin.

y

Flows easily into the post space, yet it is stackable so that you can build a sufficient amount of core material without the material slumping.

y

Transition from core material to natural tooth is smooth and free from gouging.

y

Available in two esthetic shades (A2, A3), as well as White Opaque and Blue.

FIG. 3

Learn More FIG. 4

Post cemented in canal with Zircules and cured.

2. Dallari, A., Mason, P., Rovatti, L., Dallari, B. Effect of surface treatments on retention of quartz-fiber posts. J Dent Res. Vol 87 (Spec. Iss. C) Abstract #0383, PEF Division 2008 (www. dentalresearch.org).

• A non-aggressive matching post drill that removes as little tooth structure as possible.

| Fall 2022 |

FIG. 2

Core Material That Really Stacks Up

REFERENCES

• Some macro-retentive features, grooves or spirals, and anti-rotation design to enhance bonding success2.

10

Completed RCT with post space in palatal root.

Zircules 5 mL syringe

Zircules 25 mL cartridges

A2 406502 A3 406503 Blue 406504 WO 406501

A2 406922 A3 406923 Blue 406924 WO 406921

FIG. 5

Core incrementally built-up and cured.

Dentistry and photography courtesy of Christopher Ramsey, DMD © Clinician’s Choice Dental Products, Inc. 2022. All rights reserved.

INNOVATIVE SOLUTIONS

Minimally Invasive Endodontics

Which Endo File is Right for Me? OUTLINES

n early 2022, CRD had the pleasure of announcing the new partnership with SS White, to carry their line of endodontic files exclusively in Canada. These have met with critical acclaim and have answered clinical challenges faced in endodontics by both Endodontists and General Practitioners. As there are 4 different brands of instruments, we have had a variety of questions regarding the differences, advantages, and design features of each. The following is a brief overview of the products.

PROPERTIES IN COMMON

All of the SS White files in our portfolio are designed to draw debris coronally and have excellent cutting ability. Each File series are also subject to a proprietary Heat Matrix™ process, which renders them among the most flexible endo files on the market.

MODERN DESIGN, MINIMALLY INVASIVE FILES

In the quest for endodontic success, there is one aspect of endodontic treatment has gained a lot of attention in the last 10 years, that is, retaining as much structural integrity of the as tooth possible. This is important, particularly in the area known as the Pericervical Dentin, “located 4 mm above the crestal bone and extending 4 mm apical to the crestal bone. It acts as the “neck” of the tooth” A structurally sound endodontically treated tooth, is a highly restorable tooth.

MOST POPULAR

Our most popular, flagship file, is the Exact TaperH DC™. This file preserves pericervical dentin, the critical area of the tooth. Designed with a diminishing taper, the resulting shape is the best of both worlds: deep shape where you need it, in the apical third, while conserving as much as 40% more dentin in the Coronal and mid third. The file sequence is familiar to most dentists, so there is no lengthy learning curve. Exact TaperH DC™

MOST MINIMALLY INVASIVE

DCTaperH files were the first, and continue to be the most minimally invasive files on the market. With a maximum cutting flute of .69mm and a strong parabolic core design (FIG 1, 2), and Heat matrix Technology, this file delivers strength, ultimate flexibility, and an anatomic design. These have appealed to many endodontists who are moving away from larger shapes. Our specialists have CBCT, high magnification microscopes, high intensity light, and a growing number are moving to advanced Irrigation procedures, using devices such as Gentle Wave® (Sonendo, Laguna Hills, CA) or SkyPulse® (Fotona LLC, Irving, TX). These technologies dovetail beautifully with this file. DCTaperH is the perfect file for Endodontists and minimally invasive General Practitioners. DCTaperH™

FIG. 1

FIG. 2

TRADITIONAL SHAPING FILES Many doctors still prefer the traditional shape, a gradually tapering funnel with the smallest diameter at the apex, with sufficient shape to allow for three dimensional obturation, and efficient irrigation. This group can be further divided into two subcategories, Rotary and Reciprocating Files.

Internal Bleaching

Isolate

Post & Core

Diagnose

E OS GN IA D

I

by Mr. Brian Bevan, Endodontic Product Manager

For every stage of the process, whatever clinical challenge you encounter, we can help you achieve success.

RES TO RE

PRODUCT SPOTLIGHT

Coronal Seal

Access

Pulp Capping

Repair

ROTARY

Exact Taper H is a robust and efficient cutting, variable taper file. It has been designed to emulate some of the design features of the ProTaper® Gold (Dentsply Sirona) with intuitive shapes and sizes. (i.e., F1, F2, S1, S2, etc.) These files efficiently create a traditional Rotary Shape, with super elasticity, which exceeds the competitors, and with a leap forward in resistance to cyclic fatigue.

Clinician’s Choice® True™ Dental Dam

Intra-Canal Treatment

RECIPROCATING Exact Flow H has the same design as Wave™ One Gold and can operate at the same reciprocating degrees. However, these files deliver optimal strength and flexibility, again, due to the Heat Matrix technology. They are sterilizable and VERY cost competitive. Whether you prefer a more traditional shape, a design to conserve pericervical dentin, a very minimally invasive design, rotary, or reciprocation, we have the file for you. Try a test drive, you won’t be disappointed.

Instrumentation

Obturation

Komet® Endo Tracer

Irrigation

TRE AT SS White® Files

Angelus® Bioceramics

i Minimally Invasive Root Canal Instrumentation Gustavo De-Deus, Emmanuel J. N. L. Silva, Jorge N. R. Martins, Daniele Cavalcante, Felipe G. Belladonna & Gianluca Plotino. © 2020 Springer Nature Switzerland AG ii Deep Makati, Nimisha Chinmay Shah, Dexter Brave, Vishnu Pratap Singh Rathore, Dhaval Bhadra, and Meetkumar S. Dedania. Evaluation of remaining dentin thickness and fracture resistance of conventional and conservative access and biomechanical preparation in molars using cone-beam computed tomography: An in vitro study. J Conserv Dent. 2018 May-Jun; 21(3): 324–327.

Cosmedent® Cosmecore™

Explore the entire line of SS White files

Clinician’s Choice® Zircules

Ultradent™ Opalescence™ Endo

Angelus® Exacto Translucent Post

CLINICAL EXCELLENCE from Clinical Research Dental

Shop the Endo Collection

1-800-265-3444 13 CLINICALRESEARCHDENTAL.COM

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

INNOVATIVE SOLUTIONS

Minimally Invasive Endodontics

Which Endo File is Right for Me? OUTLINES

n early 2022, CRD had the pleasure of announcing the new partnership with SS White, to carry their line of endodontic files exclusively in Canada. These have met with critical acclaim and have answered clinical challenges faced in endodontics by both Endodontists and General Practitioners. As there are 4 different brands of instruments, we have had a variety of questions regarding the differences, advantages, and design features of each. The following is a brief overview of the products.

PROPERTIES IN COMMON

All of the SS White files in our portfolio are designed to draw debris coronally and have excellent cutting ability. Each File series are also subject to a proprietary Heat Matrix™ process, which renders them among the most flexible endo files on the market.

MODERN DESIGN, MINIMALLY INVASIVE FILES

In the quest for endodontic success, there is one aspect of endodontic treatment has gained a lot of attention in the last 10 years, that is, retaining as much structural integrity of the as tooth possible. This is important, particularly in the area known as the Pericervical Dentin, “located 4 mm above the crestal bone and extending 4 mm apical to the crestal bone. It acts as the “neck” of the tooth” A structurally sound endodontically treated tooth, is a highly restorable tooth.

MOST POPULAR

Our most popular, flagship file, is the Exact TaperH DC™. This file preserves pericervical dentin, the critical area of the tooth. Designed with a diminishing taper, the resulting shape is the best of both worlds: deep shape where you need it, in the apical third, while conserving as much as 40% more dentin in the Coronal and mid third. The file sequence is familiar to most dentists, so there is no lengthy learning curve. Exact TaperH DC™

MOST MINIMALLY INVASIVE

DCTaperH files were the first, and continue to be the most minimally invasive files on the market. With a maximum cutting flute of .69mm and a strong parabolic core design (FIG 1, 2), and Heat matrix Technology, this file delivers strength, ultimate flexibility, and an anatomic design. These have appealed to many endodontists who are moving away from larger shapes. Our specialists have CBCT, high magnification microscopes, high intensity light, and a growing number are moving to advanced Irrigation procedures, using devices such as Gentle Wave® (Sonendo, Laguna Hills, CA) or SkyPulse® (Fotona LLC, Irving, TX). These technologies dovetail beautifully with this file. DCTaperH is the perfect file for Endodontists and minimally invasive General Practitioners. DCTaperH™

FIG. 1

FIG. 2

TRADITIONAL SHAPING FILES Many doctors still prefer the traditional shape, a gradually tapering funnel with the smallest diameter at the apex, with sufficient shape to allow for three dimensional obturation, and efficient irrigation. This group can be further divided into two subcategories, Rotary and Reciprocating Files.

Internal Bleaching

Isolate

Post & Core

Diagnose

E OS GN IA D

I

by Mr. Brian Bevan, Endodontic Product Manager

For every stage of the process, whatever clinical challenge you encounter, we can help you achieve success.

RES TO RE

PRODUCT SPOTLIGHT

Coronal Seal

Access

Pulp Capping

Repair

ROTARY

Exact Taper H is a robust and efficient cutting, variable taper file. It has been designed to emulate some of the design features of the ProTaper® Gold (Dentsply Sirona) with intuitive shapes and sizes. (i.e., F1, F2, S1, S2, etc.) These files efficiently create a traditional Rotary Shape, with super elasticity, which exceeds the competitors, and with a leap forward in resistance to cyclic fatigue.

Clinician’s Choice® True™ Dental Dam

Intra-Canal Treatment

RECIPROCATING Exact Flow H has the same design as Wave™ One Gold and can operate at the same reciprocating degrees. However, these files deliver optimal strength and flexibility, again, due to the Heat Matrix technology. They are sterilizable and VERY cost competitive. Whether you prefer a more traditional shape, a design to conserve pericervical dentin, a very minimally invasive design, rotary, or reciprocation, we have the file for you. Try a test drive, you won’t be disappointed.

Instrumentation

Obturation

Komet® Endo Tracer

Irrigation

TRE AT SS White® Files

Angelus® Bioceramics

i Minimally Invasive Root Canal Instrumentation Gustavo De-Deus, Emmanuel J. N. L. Silva, Jorge N. R. Martins, Daniele Cavalcante, Felipe G. Belladonna & Gianluca Plotino. © 2020 Springer Nature Switzerland AG ii Deep Makati, Nimisha Chinmay Shah, Dexter Brave, Vishnu Pratap Singh Rathore, Dhaval Bhadra, and Meetkumar S. Dedania. Evaluation of remaining dentin thickness and fracture resistance of conventional and conservative access and biomechanical preparation in molars using cone-beam computed tomography: An in vitro study. J Conserv Dent. 2018 May-Jun; 21(3): 324–327.

Cosmedent® Cosmecore™

Explore the entire line of SS White files

Clinician’s Choice® Zircules

Ultradent™ Opalescence™ Endo

Angelus® Exacto Translucent Post

CLINICAL EXCELLENCE from Clinical Research Dental

Shop the Endo Collection

1-800-265-3444 13 CLINICALRESEARCHDENTAL.COM

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

5

on

1 @dmdsunny Scan to learn more about A.S.A.P. Polishers

14

| Fall 2022 |

From 5 Restorative Educators

A.S.A.P.

All Surface Access Polishers

“

Spend time learning from Dr. Sunny Virdi and Dr. Paresh Shah and enhance your dental education with Elevate Dentistry. Participate in hands-on workshops to implement and level up your clinical skills immediately. Visit @dmdsunny on Instagram for upcoming course events and program details.

5 Clinical Must-Haves

with Dr. Sunny Virdi A key factor in creating longevity in our work and keeping our patients smiling is the finishing and polishing step. I have tried many polishers on the market, and some were more successful in my hands than others. I was on a mission to find a system that worked consistently for all the different restorations I employ in my clinic. After having tried A.S.A.P. (All Surface Access Polishers), they instantly became a staple product in the operatory, helping us achieve a remarkable shine on our restorations. The combination of the pre-polish spiral, followed by the high shine polisher creates a unique polish that rivals ceramic. After using the A.S.A.P.’s for about 20 seconds each in sequence, I’ve been able to produce the highest shine possible of the resin material in use. I was also impressed with the longevity of the polishers themselves. Highly recommended, you won’t be disappointed.

2 “

True Dental Dam with Dr. Tony Mennito

In modern dentistry, almost every procedure requires us to bond some dental material to tooth structure. And we must work in an environment that couldn’t be less conducive to this process being successful. Impeccable isolation is a must to ensure success of these restorations and history has shown that a well-placed rubber dam is the most effective method. So why don’t more dentists use this tool? I believe the main reason is the time (perceived or actual) that it takes to put a dam in place. For me, adoption of the True Dental Dam is when this form of isolation really became my “every patient, every time” process. Before this, I struggled with placing dams and would often give up and retreat into the ease of cotton roll isolation. The elasticity and tear resistance of the True Dental Dam, along with some instruction and placement practice, has dramatically improved my clinical dentistry and concurrently lowered my stress level during adhesive procedures. Dr. Tony Mennito is an instructor with both the MOD Institute and imPRES in Charleston, SC. The MOD Institute provides practical hands-on learning from world-class instructors that combines modern technology with evidencebased workflows and practices. To learn more, visit: www.themodinstitute.com @smileprofessor

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Scan to learn more about True Dental Dam

3 4 “

“

Compo-Ject

with Dr. Amanda Seay

I do have a favorite product that I don’t want to practice without and it is an instrument that doesn’t get enough attention in general: the composite gun. While we spend a great deal of time worrying about what composite and bonding resin we should be using (and rightfully so), the composite gun can make life so much easier for those of us who use compules in our composite techniques. The Compo-Ject from Clinician’s Choice is my favorite by far. Most composite guns are made from plastic which is fine, except that they can develop a film or accumulate old composite that just doesn’t look clean over time. The Compo-Ject is a sleek, cool looking, stainless steel luxury car of the composite guns. Unit dose compules snap easily into place and don’t pop out when you swivel the compule which can be so frustrating. Unloading the Compo-Ject is even easier and it feels great in my hand. Instead of just wiping it down, you can sterilize the Compo-Ject the same way you sterilize the rest of your stainless steel instruments. The Compo-Ject is a definite must-have in my operatory. Dr. Amanda Seay and Dr. Adamo Notarantonio are the founders of imPRES courses that provide the latest techniques in esthetic and restorative dentistry through cutting edge, hands-on continuing dental education. imPRES courses are designed to improve the skills of the attendee so that they can put those techniques into practice the very next day. Follow @doctorseay @adamoelvis on Instagram and visit www.imprescourses.com for more information.

Composite Ninja with Dr. Devin McClintock

Every day. Every case. If there is one instrument that I use for virtually all of my anterior and posterior restorative cases, it is the Composite Ninja from Clinician’s Choice. I love the thin double ends that are able to access anywhere interproximally whether you want to remove excess cured composite and adhesive or use the Ninja to shape and thin composite prior to light-curing. The rigid blades are multi-angled and offset so the instrument is always ergonomically centered in my hand and won’t bend away so I am always in full control. The Composite Ninja is exceptionally useful when layering composite and you need to tuck and thin the composite interproximally. Its sharp edge cleaves off any excess composite at the incisal edge without spreading or pulling on the composite. The Composite Ninja is so versatile that it is literally five instruments to me.

@mcclintockdds Scan to learn more about Composite Ninja

Scan to learn more about Compo-Ject

5

Final Shine

“

Dr. McClintock was one of a few clinicians in the country selected to partake in a 2-year residency program through the American Academy of Cosmetic Dentistry. Get incredible exposure, hands-on training, and unparalleled experience in the field of responsible esthetics with the AACD residency program. For more information, visit: www.aacd.com/residency

@doctorseay

with Dr. David Chan

With the time and effort that I take to reproduce natural anatomy in my anterior composite restorations, I cannot imagine my finishing and polishing protocol without the Final Shine Cotton Polishing Wheel from Clinician’s Choice. Final Shine in combination with a high quality aluminum oxide polishing paste magically brings out the highest shine in my anterior composites. There is nothing else on the market to match Final Shine’s fluffy cotton fibers in their ability to enable the polishing paste to penetrate the perikymata that has been carefully created. With just a few light brushing strokes with little pressure and a small amount of polishing paste the disposable Final Shine transforms the textured composite surface into a natural high-luster shine. I couldn’t achieve my esthetic objective without it.

Strive for excellence in composite dentistry by learning at the hands of Dr. David Chan at The Center for Dental Artistry in Ridgefield, WA. The Center for Dental Artistry was an idea born by the vision of Dr. David K. Chan with the goal of providing dentists with an unparalleled interactive educational opportunity to learn the art of composite dentistry that can rival the natural beauty of human tooth structure. At this state-of the-art educational center, we are committed to helping you succeed by offering small classes, hands-on workshops, and passionate instructors that focus on the details to strive for excellence. For more information, visit: www.centerfordentalartistry.net @david_k._chan

Scan to learn more about Final Shine

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

15

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

5

on

1 @dmdsunny Scan to learn more about A.S.A.P. Polishers

14

| Fall 2022 |

From 5 Restorative Educators

A.S.A.P.

All Surface Access Polishers

“

Spend time learning from Dr. Sunny Virdi and Dr. Paresh Shah and enhance your dental education with Elevate Dentistry. Participate in hands-on workshops to implement and level up your clinical skills immediately. Visit @dmdsunny on Instagram for upcoming course events and program details.

5 Clinical Must-Haves

with Dr. Sunny Virdi A key factor in creating longevity in our work and keeping our patients smiling is the finishing and polishing step. I have tried many polishers on the market, and some were more successful in my hands than others. I was on a mission to find a system that worked consistently for all the different restorations I employ in my clinic. After having tried A.S.A.P. (All Surface Access Polishers), they instantly became a staple product in the operatory, helping us achieve a remarkable shine on our restorations. The combination of the pre-polish spiral, followed by the high shine polisher creates a unique polish that rivals ceramic. After using the A.S.A.P.’s for about 20 seconds each in sequence, I’ve been able to produce the highest shine possible of the resin material in use. I was also impressed with the longevity of the polishers themselves. Highly recommended, you won’t be disappointed.

2 “

True Dental Dam with Dr. Tony Mennito

In modern dentistry, almost every procedure requires us to bond some dental material to tooth structure. And we must work in an environment that couldn’t be less conducive to this process being successful. Impeccable isolation is a must to ensure success of these restorations and history has shown that a well-placed rubber dam is the most effective method. So why don’t more dentists use this tool? I believe the main reason is the time (perceived or actual) that it takes to put a dam in place. For me, adoption of the True Dental Dam is when this form of isolation really became my “every patient, every time” process. Before this, I struggled with placing dams and would often give up and retreat into the ease of cotton roll isolation. The elasticity and tear resistance of the True Dental Dam, along with some instruction and placement practice, has dramatically improved my clinical dentistry and concurrently lowered my stress level during adhesive procedures. Dr. Tony Mennito is an instructor with both the MOD Institute and imPRES in Charleston, SC. The MOD Institute provides practical hands-on learning from world-class instructors that combines modern technology with evidencebased workflows and practices. To learn more, visit: www.themodinstitute.com @smileprofessor

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

Scan to learn more about True Dental Dam

3 4 “

“

Compo-Ject

with Dr. Amanda Seay

I do have a favorite product that I don’t want to practice without and it is an instrument that doesn’t get enough attention in general: the composite gun. While we spend a great deal of time worrying about what composite and bonding resin we should be using (and rightfully so), the composite gun can make life so much easier for those of us who use compules in our composite techniques. The Compo-Ject from Clinician’s Choice is my favorite by far. Most composite guns are made from plastic which is fine, except that they can develop a film or accumulate old composite that just doesn’t look clean over time. The Compo-Ject is a sleek, cool looking, stainless steel luxury car of the composite guns. Unit dose compules snap easily into place and don’t pop out when you swivel the compule which can be so frustrating. Unloading the Compo-Ject is even easier and it feels great in my hand. Instead of just wiping it down, you can sterilize the Compo-Ject the same way you sterilize the rest of your stainless steel instruments. The Compo-Ject is a definite must-have in my operatory. Dr. Amanda Seay and Dr. Adamo Notarantonio are the founders of imPRES courses that provide the latest techniques in esthetic and restorative dentistry through cutting edge, hands-on continuing dental education. imPRES courses are designed to improve the skills of the attendee so that they can put those techniques into practice the very next day. Follow @doctorseay @adamoelvis on Instagram and visit www.imprescourses.com for more information.

Composite Ninja with Dr. Devin McClintock

Every day. Every case. If there is one instrument that I use for virtually all of my anterior and posterior restorative cases, it is the Composite Ninja from Clinician’s Choice. I love the thin double ends that are able to access anywhere interproximally whether you want to remove excess cured composite and adhesive or use the Ninja to shape and thin composite prior to light-curing. The rigid blades are multi-angled and offset so the instrument is always ergonomically centered in my hand and won’t bend away so I am always in full control. The Composite Ninja is exceptionally useful when layering composite and you need to tuck and thin the composite interproximally. Its sharp edge cleaves off any excess composite at the incisal edge without spreading or pulling on the composite. The Composite Ninja is so versatile that it is literally five instruments to me.

@mcclintockdds Scan to learn more about Composite Ninja

Scan to learn more about Compo-Ject

5

Final Shine

“

Dr. McClintock was one of a few clinicians in the country selected to partake in a 2-year residency program through the American Academy of Cosmetic Dentistry. Get incredible exposure, hands-on training, and unparalleled experience in the field of responsible esthetics with the AACD residency program. For more information, visit: www.aacd.com/residency

@doctorseay

with Dr. David Chan

With the time and effort that I take to reproduce natural anatomy in my anterior composite restorations, I cannot imagine my finishing and polishing protocol without the Final Shine Cotton Polishing Wheel from Clinician’s Choice. Final Shine in combination with a high quality aluminum oxide polishing paste magically brings out the highest shine in my anterior composites. There is nothing else on the market to match Final Shine’s fluffy cotton fibers in their ability to enable the polishing paste to penetrate the perikymata that has been carefully created. With just a few light brushing strokes with little pressure and a small amount of polishing paste the disposable Final Shine transforms the textured composite surface into a natural high-luster shine. I couldn’t achieve my esthetic objective without it.

Strive for excellence in composite dentistry by learning at the hands of Dr. David Chan at The Center for Dental Artistry in Ridgefield, WA. The Center for Dental Artistry was an idea born by the vision of Dr. David K. Chan with the goal of providing dentists with an unparalleled interactive educational opportunity to learn the art of composite dentistry that can rival the natural beauty of human tooth structure. At this state-of the-art educational center, we are committed to helping you succeed by offering small classes, hands-on workshops, and passionate instructors that focus on the details to strive for excellence. For more information, visit: www.centerfordentalartistry.net @david_k._chan

Scan to learn more about Final Shine

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

15

SOLUTIONS FOR

CLINICAL EXCELLENCE BT Matrices are extremely popular because they are recipe based, and the simplicity of them provides a great advantage. The BT Matrix Series is made up of four Bioclear cervical curvatures (pink, yellow, green, and blue). They come in sizes large and small. The BT kit includes the 8-matrix assortment, a color-coded sizing gauge, interproximal sanders to allow for matrix seating, and disclosing solution. BT matrices have a helpful broad contact and are meant to be used in interproximal pairs for black triangles and by themselves interproximally for diastema closure or 360° veneering. Figures 6 and 7 (courtesy Dr. Richard Young) show large BT matrices in action for a diastema closure and figures 8 and 9 feature the small BT matrices for lower incisor black triangle rejuvenation.

Bioclear Matrix Choices for 2023

B

ioclear was founded in 2007 and throughout the years, has worked to continuously improve the doctor and patient experience. If you have been using Bioclear since the beginning or are just starting, this quick matrix selection overview should be a helpful tool.

David Clark, DDS Bioclear Matrix Creator and President Dr. Clark is the director of Bioclear Learning Centers International. He founded the Academy of Microscope Enhanced Dentistry, creates curriculum for dental schools and has lectured in 25 countries. Dr. Clark developed the Bioclear Matrix System for placement of biologically appropriate, esthetically pleasing direct composite restorations for facilitating Injection Molding of the Clark Class I and Class II preparations, diastema closure, and black triangle elimination.

Originally in 2007, all of the Bioclear matrices were 50-microns in thickness, which is the same thickness as the old-school flat Mylar that we have suffered with for decades. Because of the curvature of the original 50-micron matrices, the matrices are stronger and stiffer than the 50-micron flat Mylar. In 2015, Bioclear introduced 75-micron Heavy Duty or “HD” matrices. When using the HD matrices, they feel at least twice as strong and stiff as the 50-micron version. In my practice and at the Bioclear Learning Center, we exclusively use and teach the HD matrices. Many doctors who began using Bioclear early on are still using the 50-micron variety and have success in their restorations because they have trained their hands to use it. If you are new to Bioclear, I recommend starting out with the HD matrices because they are easier to work with. If you are still using the 50-micron version, you should give the HD version a try.

FIG. 1

FIG. 2

BIOCLEAR ANTERIOR MATRICES Bioclear now has three families of anterior matrices, Classic Bioclear, The BT or Black Triangle matrices, and the 360° veneer matrices. Of those three families, only the classic anterior matrices are available in both 50-micron and 75-micron (HD) thickness. The HD matrices have a slightly frosty opacified look that distinguishes them from the 50-micron version.

FIG. 3

Classic Bioclear is great for everyday Class III and Class IV restorations. In figures 1-5, you see back-to-back matrices, A-102 HD on the distal of the central incisor and A-103 HD on the mesial of the lateral incisor. Bioclear has changed the wedge algorithm, and we are always asked, “When do you use a wedge?” The answer is, “When they will serve me well.” In this case, we used a small (pink) Diamond Wedge because we were not trying to close a black triangle, and there was enough cervical tooth structure present to stabilize the wedge.

FIG. 6

FIG. 7

FIG. 8

FIG. 9

360˚ Veneer Matrices are designed for the upper arch, canine to canine; they are the ultimate volume matrix. The 360° Veneer matrices are great for severe wear cases, VDO cases, and cases where you need to add at least one millimeter of composite thickness to brighten dark teeth. In figures 10 - 14, you see a severe wear case that has end-to-end occlusion. I opened the vertical dimension two and a half millimeters and pushed the teeth facially to achieve a better overjet.

Biofit posterior matrices are for molars in 4.5, 5.5, and 6.5mm heights. The very popular premolar matrix comes in 5.5 mm heights. Figure 15 shows two Biofit premolar matrices next to a blue Evolve matrix. Biofit matrices are great for younger patients, but for adults and deep cases, we developed the Evolve Matrix Series.

Evolve matrices come in a wide array of heights, from 5mm to 9mm. Like the BT matrices, they are colour coded for emergence profile. For Evolve, the three colours offered are blue, orange, and pink. As you move from blue to pink, the emergence profiles get flatter and the matrices buccal-lingual width increases. Colour coding and printed heights on the matrices make them easier to use because they are much more visible in and out of the mouth, and the design helps eliminate confusion. The Evolve matrices also have a gingival extension for deep decay as shown in figure 16-18. An indispensable tool to help determine the correct matrix height is the Evolve Matrix Height Indicator (EMHI), shown in figure 19. Figure 20 shows the 9mm blue Evolve being used to overlay and veneer a bicuspid in a VDO case. For a full description of the Evolve Matrix Series, make sure to see the full technique product guide.

FIG. 16

When do you use a wedge with anterior Bioclear matrices? For black triangles and diastema closures, I do not use wedges because there is no “hip” of tooth structure to stabilize the wedge. But, you can do “delayed wedging” for diastema closures. For deep interproximal decay, I treat it just like a diastema closure.

FIG. 10

FIG. 15

FIG. 17

FIG. 18

FIG. 11 FIG. 19

FIG. 4

FIG. 12

FIG. 13

Before

BIOCLEAR POSTERIOR MATRICES

FIG. 5 After

16

| Fall 2022 |

FIG. 14

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

There are now two families of matrices for posterior teeth: The Biofit Matrix Series and the Evolve Matrix Series. The Biofit matrices come in both 50-micron and 75-micron HD thicknesses. The new Evolve matrices are colour coded for emergence profile and width, and come in 75-micron thickness HD. CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

FIG. 20

17

SOLUTIONS FOR

CLINICAL EXCELLENCE BT Matrices are extremely popular because they are recipe based, and the simplicity of them provides a great advantage. The BT Matrix Series is made up of four Bioclear cervical curvatures (pink, yellow, green, and blue). They come in sizes large and small. The BT kit includes the 8-matrix assortment, a color-coded sizing gauge, interproximal sanders to allow for matrix seating, and disclosing solution. BT matrices have a helpful broad contact and are meant to be used in interproximal pairs for black triangles and by themselves interproximally for diastema closure or 360° veneering. Figures 6 and 7 (courtesy Dr. Richard Young) show large BT matrices in action for a diastema closure and figures 8 and 9 feature the small BT matrices for lower incisor black triangle rejuvenation.

Bioclear Matrix Choices for 2023

B

ioclear was founded in 2007 and throughout the years, has worked to continuously improve the doctor and patient experience. If you have been using Bioclear since the beginning or are just starting, this quick matrix selection overview should be a helpful tool.

David Clark, DDS Bioclear Matrix Creator and President Dr. Clark is the director of Bioclear Learning Centers International. He founded the Academy of Microscope Enhanced Dentistry, creates curriculum for dental schools and has lectured in 25 countries. Dr. Clark developed the Bioclear Matrix System for placement of biologically appropriate, esthetically pleasing direct composite restorations for facilitating Injection Molding of the Clark Class I and Class II preparations, diastema closure, and black triangle elimination.

Originally in 2007, all of the Bioclear matrices were 50-microns in thickness, which is the same thickness as the old-school flat Mylar that we have suffered with for decades. Because of the curvature of the original 50-micron matrices, the matrices are stronger and stiffer than the 50-micron flat Mylar. In 2015, Bioclear introduced 75-micron Heavy Duty or “HD” matrices. When using the HD matrices, they feel at least twice as strong and stiff as the 50-micron version. In my practice and at the Bioclear Learning Center, we exclusively use and teach the HD matrices. Many doctors who began using Bioclear early on are still using the 50-micron variety and have success in their restorations because they have trained their hands to use it. If you are new to Bioclear, I recommend starting out with the HD matrices because they are easier to work with. If you are still using the 50-micron version, you should give the HD version a try.

FIG. 1

FIG. 2

BIOCLEAR ANTERIOR MATRICES Bioclear now has three families of anterior matrices, Classic Bioclear, The BT or Black Triangle matrices, and the 360° veneer matrices. Of those three families, only the classic anterior matrices are available in both 50-micron and 75-micron (HD) thickness. The HD matrices have a slightly frosty opacified look that distinguishes them from the 50-micron version.

FIG. 3

Classic Bioclear is great for everyday Class III and Class IV restorations. In figures 1-5, you see back-to-back matrices, A-102 HD on the distal of the central incisor and A-103 HD on the mesial of the lateral incisor. Bioclear has changed the wedge algorithm, and we are always asked, “When do you use a wedge?” The answer is, “When they will serve me well.” In this case, we used a small (pink) Diamond Wedge because we were not trying to close a black triangle, and there was enough cervical tooth structure present to stabilize the wedge.

FIG. 6

FIG. 7

FIG. 8

FIG. 9

360˚ Veneer Matrices are designed for the upper arch, canine to canine; they are the ultimate volume matrix. The 360° Veneer matrices are great for severe wear cases, VDO cases, and cases where you need to add at least one millimeter of composite thickness to brighten dark teeth. In figures 10 - 14, you see a severe wear case that has end-to-end occlusion. I opened the vertical dimension two and a half millimeters and pushed the teeth facially to achieve a better overjet.

Biofit posterior matrices are for molars in 4.5, 5.5, and 6.5mm heights. The very popular premolar matrix comes in 5.5 mm heights. Figure 15 shows two Biofit premolar matrices next to a blue Evolve matrix. Biofit matrices are great for younger patients, but for adults and deep cases, we developed the Evolve Matrix Series.

Evolve matrices come in a wide array of heights, from 5mm to 9mm. Like the BT matrices, they are colour coded for emergence profile. For Evolve, the three colours offered are blue, orange, and pink. As you move from blue to pink, the emergence profiles get flatter and the matrices buccal-lingual width increases. Colour coding and printed heights on the matrices make them easier to use because they are much more visible in and out of the mouth, and the design helps eliminate confusion. The Evolve matrices also have a gingival extension for deep decay as shown in figure 16-18. An indispensable tool to help determine the correct matrix height is the Evolve Matrix Height Indicator (EMHI), shown in figure 19. Figure 20 shows the 9mm blue Evolve being used to overlay and veneer a bicuspid in a VDO case. For a full description of the Evolve Matrix Series, make sure to see the full technique product guide.

FIG. 16

When do you use a wedge with anterior Bioclear matrices? For black triangles and diastema closures, I do not use wedges because there is no “hip” of tooth structure to stabilize the wedge. But, you can do “delayed wedging” for diastema closures. For deep interproximal decay, I treat it just like a diastema closure.

FIG. 10

FIG. 15

FIG. 17

FIG. 18

FIG. 11 FIG. 19

FIG. 4

FIG. 12

FIG. 13

Before

BIOCLEAR POSTERIOR MATRICES

FIG. 5 After

16

| Fall 2022 |

FIG. 14

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

There are now two families of matrices for posterior teeth: The Biofit Matrix Series and the Evolve Matrix Series. The Biofit matrices come in both 50-micron and 75-micron HD thicknesses. The new Evolve matrices are colour coded for emergence profile and width, and come in 75-micron thickness HD. CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

FIG. 20

17

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

Utilizing a Soft Tissue Diode Laser for a Direct Resin Restoration

D

Light the Way to Surgical Accuracy The Bluewave diode laser is powerful and simple to use and is easily portable from operatory to operatory.

Troy Schmedding

DDS, AAACD

Dr. Troy Schmedding is a 1993 honors graduate of the Arthur A. Dugoni School of Dentistry in San Francisco, California. He maintains a private practice in Walnut Creek, CA. where he focuses on aesthetic and functional dentistry. An Accredited member of the American Academy of Cosmetic Dentistry, he lectures both nationally and internationally on aesthetics and restorative materials. He has also written and published numerous articles on restorative materials and protocols in numerous dental magazines. Dr. Schmedding also serves as a Key Opinion Leader for numerous manufacturers, helping develop and bring new products to market.

- Susan McMahon, DMD, AAACD, FAGD

With enhanced procedural efficiency, the versatile Bluewave™ Soft Tissue Diode Laser is ready for many restorative or periodontal indications and boasts up to 5W of power and three pre-programmed settings (debride, perio, and cut). y

With its compact size and wireless foot pedal, the Bluewave offers true lightweight portability, while its robust lithium-ion rechargeable battery allows for up to 3 hours of continuous use on every charge.

y

For increased accuracy, Bluewave’s unique blue guiding light produces higher contrast on oral tissues.

Follow us!

Saving both time and frustration, Bluewave’s disposable tips (Regular 4mm, Perio 9mm) are designed for convenience and safety by eliminating the extra steps of oducts, Inc. 2021. All rights reserved. stripping or cleaving fiber. y

clinicianschoice.com Dentistry and photography courtesy of Susan McMahon, DMD, AAACD, FAGD

(444000) Bluewave Soft (444006) 4mm Regular Tips (444007) 9mm Regular Tips

* Includes

12

oducts, Inc. 2021. All ONLINE rights reserved.

Tissue Diode Laser

Follow us!

Diode lasers such as the Bluewave (Clinician’s Choice) provide sufficient power to modify soft tissue or alteration of the gingival margin to improve the working field of the operator while working in a temperature range recommended to avoid negatively affecting osseous support. The 810 nm diode laser is engineered to make laser therapy truly convenient and expedient. Featuring a long-lasting lithium-ion battery, light-weight design, and wireless foot pedal, the Bluewave is truly portable and allows the clinician to move between operatories with ease. Three intuitive and easy-to-use settings simplify treatment protocols, with an additional custom setting for individual user’s preferences. Its unique blueaiming beam produces higher contrast on oral tissues and blood than the traditional red beam for enhanced visibility and efficiency. The curved, ergonomic contours of the handpiece provide better posterior access in multiple positions, reducing hand fatigue during longer procedures. Disposable tips eliminate the inconvenience and inconsistency of strip-and-cleave systems. The case we highlight is one of the many opportunities for which a soft tissue laser can be utilized to provide an optimal outcome. In this particular case we find ourselves making a decision on whether or not we can restore this tooth without having to replace the existing restoration. Mesial buccal decay under an existing crown can provide a challenge for any clinician. (FIG. 1)

CE CREDITS

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

clinicianschoice.com

FIG. 2

Working from the pre-set “cut” button, I slowly began to remove the necessary tissue needed to allow for the proper access for decay removal as well as restoration placement. The ability of the laser to control the hemostasis in the area made it ideal. (FIG. 3)

FIG. 3

After following my bonding protocol, we were able to place our final restoration in a stress-free environment due to the Bluewave controlling a very difficult situation. (FIG. 4)

The soft tissue diode laser has become a “must have” mainstream technology for every general practice. The science, ease of use, and affordability make it simple to incorporate. The laser is now the essential “soft tissue handpiece” for my practice.

Valued at $550

© Clinician’s Dental Products, Inc. 2022. All rights reserved. oducts, Inc. 2021.Choice All rights reserved.

Patient’s age and financials being an issue, it was decided to repair the existing crown with a direct resin restoration. Being able to control the environment, a DryShield (DryShield) was placed and my 4mm Bluewave fiber tip was initiated with aid of carbon paper. (FIG. 2)

FIG. 4

clinicianschoice.com

Follow us!

20

iode lasers are becoming increasingly utilized in dental practices, both because they are less expensive to implement than CO2 and Nd:YAG lasers and due to the wide range of effective treatments afforded by these devices. Soft tissue laser uses include sulcular debridement, reduction of bacterial levels in periodontal treatment, biopsies, frenectomies and gingivectomy procedures to name a few. The use of lasers as an adjunctive or alternative option can help facilitate treatment and has the potential to improve healing and outcomes. Potential advantages over conventional methodologies include improved precision and visualization, less discomfort for patients as well as greater hemostasis for the operator to deliver ideal results. Lasers are becoming an adjunctive treatment methodology, as well as a stand-alone addition to the traditional dental armamentarium.

FIG. 1

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

19

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

Utilizing a Soft Tissue Diode Laser for a Direct Resin Restoration

D

Light the Way to Surgical Accuracy The Bluewave diode laser is powerful and simple to use and is easily portable from operatory to operatory.

Troy Schmedding

DDS, AAACD

Dr. Troy Schmedding is a 1993 honors graduate of the Arthur A. Dugoni School of Dentistry in San Francisco, California. He maintains a private practice in Walnut Creek, CA. where he focuses on aesthetic and functional dentistry. An Accredited member of the American Academy of Cosmetic Dentistry, he lectures both nationally and internationally on aesthetics and restorative materials. He has also written and published numerous articles on restorative materials and protocols in numerous dental magazines. Dr. Schmedding also serves as a Key Opinion Leader for numerous manufacturers, helping develop and bring new products to market.

- Susan McMahon, DMD, AAACD, FAGD

With enhanced procedural efficiency, the versatile Bluewave™ Soft Tissue Diode Laser is ready for many restorative or periodontal indications and boasts up to 5W of power and three pre-programmed settings (debride, perio, and cut). y

With its compact size and wireless foot pedal, the Bluewave offers true lightweight portability, while its robust lithium-ion rechargeable battery allows for up to 3 hours of continuous use on every charge.

y

For increased accuracy, Bluewave’s unique blue guiding light produces higher contrast on oral tissues.

Follow us!

Saving both time and frustration, Bluewave’s disposable tips (Regular 4mm, Perio 9mm) are designed for convenience and safety by eliminating the extra steps of oducts, Inc. 2021. All rights reserved. stripping or cleaving fiber. y

clinicianschoice.com Dentistry and photography courtesy of Susan McMahon, DMD, AAACD, FAGD

(444000) Bluewave Soft (444006) 4mm Regular Tips (444007) 9mm Regular Tips

* Includes

12

oducts, Inc. 2021. All ONLINE rights reserved.

Tissue Diode Laser

Follow us!

Diode lasers such as the Bluewave (Clinician’s Choice) provide sufficient power to modify soft tissue or alteration of the gingival margin to improve the working field of the operator while working in a temperature range recommended to avoid negatively affecting osseous support. The 810 nm diode laser is engineered to make laser therapy truly convenient and expedient. Featuring a long-lasting lithium-ion battery, light-weight design, and wireless foot pedal, the Bluewave is truly portable and allows the clinician to move between operatories with ease. Three intuitive and easy-to-use settings simplify treatment protocols, with an additional custom setting for individual user’s preferences. Its unique blueaiming beam produces higher contrast on oral tissues and blood than the traditional red beam for enhanced visibility and efficiency. The curved, ergonomic contours of the handpiece provide better posterior access in multiple positions, reducing hand fatigue during longer procedures. Disposable tips eliminate the inconvenience and inconsistency of strip-and-cleave systems. The case we highlight is one of the many opportunities for which a soft tissue laser can be utilized to provide an optimal outcome. In this particular case we find ourselves making a decision on whether or not we can restore this tooth without having to replace the existing restoration. Mesial buccal decay under an existing crown can provide a challenge for any clinician. (FIG. 1)

CE CREDITS

| Fall 2022 |

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

clinicianschoice.com

FIG. 2

Working from the pre-set “cut” button, I slowly began to remove the necessary tissue needed to allow for the proper access for decay removal as well as restoration placement. The ability of the laser to control the hemostasis in the area made it ideal. (FIG. 3)

FIG. 3

After following my bonding protocol, we were able to place our final restoration in a stress-free environment due to the Bluewave controlling a very difficult situation. (FIG. 4)

The soft tissue diode laser has become a “must have” mainstream technology for every general practice. The science, ease of use, and affordability make it simple to incorporate. The laser is now the essential “soft tissue handpiece” for my practice.

Valued at $550

© Clinician’s Dental Products, Inc. 2022. All rights reserved. oducts, Inc. 2021.Choice All rights reserved.

Patient’s age and financials being an issue, it was decided to repair the existing crown with a direct resin restoration. Being able to control the environment, a DryShield (DryShield) was placed and my 4mm Bluewave fiber tip was initiated with aid of carbon paper. (FIG. 2)

FIG. 4

clinicianschoice.com

Follow us!

20

iode lasers are becoming increasingly utilized in dental practices, both because they are less expensive to implement than CO2 and Nd:YAG lasers and due to the wide range of effective treatments afforded by these devices. Soft tissue laser uses include sulcular debridement, reduction of bacterial levels in periodontal treatment, biopsies, frenectomies and gingivectomy procedures to name a few. The use of lasers as an adjunctive or alternative option can help facilitate treatment and has the potential to improve healing and outcomes. Potential advantages over conventional methodologies include improved precision and visualization, less discomfort for patients as well as greater hemostasis for the operator to deliver ideal results. Lasers are becoming an adjunctive treatment methodology, as well as a stand-alone addition to the traditional dental armamentarium.

FIG. 1

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

19

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

7

on

“

Ultradent Favourites ™

From 7 CRD Specialists Opalescence™ PF™

“

1

Teeth Whitening Treatment

I recommend Opalescence PF gel because the results from patients using it are consistent. The sticky, viscous Opalescence PF gel is one of the reasons why this whitening is an effective solution. My customers feel better knowing they offer their patients a whitening gel that also provides beneficial results such as improving enamel health and increasing enamel microhardness with an optimum combination of potassium nitrate and fluoride. The high-water content prevents dehydration and shade relapse, making Opalescence gel the most reliable whitening gel available. For me, carbamide peroxide is also an advantage as it increases oral pH to above 7 and reduces plaque, as well as kills bacteria that cause tooth decay. I know I can rely on Opalescence PF’s five different concentrations to help my customers achieve the best possible results and meet their patients' high expectations.

4

Opalescence™ Boost™ In-Office Power Whitener & Umbrella™ Tongue, Lip, and Cheek Retractor Saliva management, visibility and access are critical in many dental procedures. The Umbrella Lip, Tongue and Cheek retractor provides patients comfort while the clinician can have a stress-free appointment focussing on the task at hand. The combination of the gentle tongue and cheek retractor with a soft built-in spring-like design gives the perfect balance of needs for both patient and operator. For example, use Umbrella when whitening patients’ teeth with Opalescence Boost. The red chemically activated whitening gel of Opalescence Boost makes chairside application efficient and comfortable, while Umbrella helps the patient hold their mouth open and keeps the tongue away from the working area! Try Opalescence Boost In-Office Whitening today, and let your patients leave your office with a boosted confidence! Scan to learn more about Opalescence Boost

Amber Nikolakis, CDA Territory Account Manager Calgary North [email protected]

UltraCal™ XS

“

30%–35% Calcium UltraCal XS is the go-to intracanal treatment for “hot” teeth in endodontic treatment. The 35% calcium hydroxide formula calms the tooth at a pH of 12 and initiates healing prior to finishing endodontic treatment in a two-visit treatment plan. Easy delivery into the canal and very easy removal with the Ultradent NaviTip FX tip when used with Ultradent Citric Acid 20%. If you need to identify it on a radiograph, its opacity shows easily! A must-have in your endo armamentarium.

Scan to learn more about Opalesence PF

Scan to learn more about UltraCal XS

Claudia Martin Regional Account Manager South Shore of Montreal [email protected] @claudiamartin_crd

Opalescence™ Go™

Teeth Whitening Treatment

“

2

Within the perfect product line of Ultradent™ Opalescence Teeth Whitening, lies my favourite product of ALL, Opalescence GO™! It is true to its name, one magical box to just take with you whether you decide to whiten after dental cleaning or use it on top of your braces. If you just want to touch up and find whitening expensive, long, and complicated, then GO is also your solution. Finally, if you are sensitive and have had troubles whitening in the past, and you want a product that stands behind its claim of superior ingredients to protect you and deliver lasting results, then use Opalescence GO.

3

“

VALO

™

“ Eleni Stathatos Territory Account Manager Montreal Downtown/West & West Island [email protected] @helenstathatos_crd Scan to learn more about Opalescence Go

LED Curing Lights

This curing light is so strong, it should wear a CAPE, because it truly is a Superhero. Its unibody is made of high-grade aerospace aluminium, and was thrown from space, only to be found in perfect working order! None of the other curing lights have this capability. Custom LEDs in three wavelengths polymerize all light-cured dental materials, and as we know today, some shades are harder to cure than others! VALO is engineering perfection! Harpreet Gahunia Territory Account Manager Kitchener/Cambridge/Waterloo/Guelph [email protected] @crdharp

Scan to learn more about VALO

Scan to learn more about Umbrella

6 “

5

Aaron Honce Territory Account Manager/ Endodontic Specialist Kamloops/Kelowna/Prince George/Vernon [email protected] @AaronHonce_CRD

UltraEZ™ Desensitizing Gel Despite the fluoride and potassium nitrate added to the Opalescence whitening formula, certain patients may still experience sensitivity. I personally struggle with sensitivity when it comes to whitening and UltraEZ has been a huge help. Prolonged contact with the teeth (1 hour) leads to pretty immediate results and doesn’t need to be used for days or weeks like sensitivity toothpaste. It has a similar viscous gel like Opalescence Go, so the tray stays where its placed and is very comfortable to wear with minimal clean up. It won’t interfere with whitening, and it’s gluten-free for those of us with sensitivities. Also, a box of UltraEZ comes with 10 sets of upper and lower pre-filled trays with five sets of instructions, so you can dispense it to your patients as needed! Scan to learn more about UltraEZ

Maggie Buchanan Inside Sales & Customer Service Manager [email protected]

Enamelast™

Fluoride Varnish

Clinicians need a patient-accepted and easy, fast way to provide fluoride treatments – whether it is for adults or more commonly for children. Enamelast fits the bill every time - hygienists love the unsurpassed fluoride uptake, adults love the clear look and smooth feel on their teeth and kids love the great flavours! Enamel protection has never been so easy or so effective! Scan to learn more about Enamelast

7

Dianne Jackson, CPDA Territory Account Manager Brampton/Etobicoke [email protected] @dianne_jackson_at_crd

21

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

7

on

“

Ultradent Favourites ™

From 7 CRD Specialists Opalescence™ PF™

“

1

Teeth Whitening Treatment

I recommend Opalescence PF gel because the results from patients using it are consistent. The sticky, viscous Opalescence PF gel is one of the reasons why this whitening is an effective solution. My customers feel better knowing they offer their patients a whitening gel that also provides beneficial results such as improving enamel health and increasing enamel microhardness with an optimum combination of potassium nitrate and fluoride. The high-water content prevents dehydration and shade relapse, making Opalescence gel the most reliable whitening gel available. For me, carbamide peroxide is also an advantage as it increases oral pH to above 7 and reduces plaque, as well as kills bacteria that cause tooth decay. I know I can rely on Opalescence PF’s five different concentrations to help my customers achieve the best possible results and meet their patients' high expectations.

4

Opalescence™ Boost™ In-Office Power Whitener & Umbrella™ Tongue, Lip, and Cheek Retractor Saliva management, visibility and access are critical in many dental procedures. The Umbrella Lip, Tongue and Cheek retractor provides patients comfort while the clinician can have a stress-free appointment focussing on the task at hand. The combination of the gentle tongue and cheek retractor with a soft built-in spring-like design gives the perfect balance of needs for both patient and operator. For example, use Umbrella when whitening patients’ teeth with Opalescence Boost. The red chemically activated whitening gel of Opalescence Boost makes chairside application efficient and comfortable, while Umbrella helps the patient hold their mouth open and keeps the tongue away from the working area! Try Opalescence Boost In-Office Whitening today, and let your patients leave your office with a boosted confidence! Scan to learn more about Opalescence Boost

Amber Nikolakis, CDA Territory Account Manager Calgary North [email protected]

UltraCal™ XS

“

30%–35% Calcium UltraCal XS is the go-to intracanal treatment for “hot” teeth in endodontic treatment. The 35% calcium hydroxide formula calms the tooth at a pH of 12 and initiates healing prior to finishing endodontic treatment in a two-visit treatment plan. Easy delivery into the canal and very easy removal with the Ultradent NaviTip FX tip when used with Ultradent Citric Acid 20%. If you need to identify it on a radiograph, its opacity shows easily! A must-have in your endo armamentarium.

Scan to learn more about Opalesence PF

Scan to learn more about UltraCal XS

Claudia Martin Regional Account Manager South Shore of Montreal [email protected] @claudiamartin_crd

Opalescence™ Go™

Teeth Whitening Treatment

“

2

Within the perfect product line of Ultradent™ Opalescence Teeth Whitening, lies my favourite product of ALL, Opalescence GO™! It is true to its name, one magical box to just take with you whether you decide to whiten after dental cleaning or use it on top of your braces. If you just want to touch up and find whitening expensive, long, and complicated, then GO is also your solution. Finally, if you are sensitive and have had troubles whitening in the past, and you want a product that stands behind its claim of superior ingredients to protect you and deliver lasting results, then use Opalescence GO.

3

“

VALO

™

“ Eleni Stathatos Territory Account Manager Montreal Downtown/West & West Island [email protected] @helenstathatos_crd Scan to learn more about Opalescence Go

LED Curing Lights

This curing light is so strong, it should wear a CAPE, because it truly is a Superhero. Its unibody is made of high-grade aerospace aluminium, and was thrown from space, only to be found in perfect working order! None of the other curing lights have this capability. Custom LEDs in three wavelengths polymerize all light-cured dental materials, and as we know today, some shades are harder to cure than others! VALO is engineering perfection! Harpreet Gahunia Territory Account Manager Kitchener/Cambridge/Waterloo/Guelph [email protected] @crdharp

Scan to learn more about VALO

Scan to learn more about Umbrella

6 “

5

Aaron Honce Territory Account Manager/ Endodontic Specialist Kamloops/Kelowna/Prince George/Vernon [email protected] @AaronHonce_CRD

UltraEZ™ Desensitizing Gel Despite the fluoride and potassium nitrate added to the Opalescence whitening formula, certain patients may still experience sensitivity. I personally struggle with sensitivity when it comes to whitening and UltraEZ has been a huge help. Prolonged contact with the teeth (1 hour) leads to pretty immediate results and doesn’t need to be used for days or weeks like sensitivity toothpaste. It has a similar viscous gel like Opalescence Go, so the tray stays where its placed and is very comfortable to wear with minimal clean up. It won’t interfere with whitening, and it’s gluten-free for those of us with sensitivities. Also, a box of UltraEZ comes with 10 sets of upper and lower pre-filled trays with five sets of instructions, so you can dispense it to your patients as needed! Scan to learn more about UltraEZ

Maggie Buchanan Inside Sales & Customer Service Manager [email protected]

Enamelast™

Fluoride Varnish

Clinicians need a patient-accepted and easy, fast way to provide fluoride treatments – whether it is for adults or more commonly for children. Enamelast fits the bill every time - hygienists love the unsurpassed fluoride uptake, adults love the clear look and smooth feel on their teeth and kids love the great flavours! Enamel protection has never been so easy or so effective! Scan to learn more about Enamelast

7

Dianne Jackson, CPDA Territory Account Manager Brampton/Etobicoke [email protected] @dianne_jackson_at_crd

21

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

The Next Generation in Composite Warming Technology Compex HD by AdDent, Inc, is awarded Catapult Education’s Vote of Confidence after evaluators test it on 100 patients. by Marc Geissberger, DDS, MA, CPT Published in Dental Products Report, July 1, 2022 Dental Products Report July 2022, Volume 56, Issue 7

W

arming composite to assist clinicians in seating restorations, placing, and manipulating composites has been in regular use since the 1980s.1 AdDent, Inc, has a long history in developing warming technology to improve clinical outcomes and provide a predictable way of effortlessly placing composite restorations.

About Catapult Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.

22

| Fall 2022 |

As composite resin technology has improved with increased strength, higher filler content, lower volumetric shrinkage, and better polishability, composite handling has become more challenging. The improvements made in composite resin technology have produced products that are far stiffer than previous generations, which has created a conundrum for clinicians. Should they continue to use inferior, older technology with easier handling or move to a new composite with dramatically improved characteristics but with significant challenges when placing the restoration because of significantly higher stiffness? Fortunately, the answer does not have to be either one or the other. Clinicians can incorporate composite warming technology and pair that with a modern, nano-filled composite of their choice, which will dramatically lower the viscosity of the composite with higher filler loading, making it easy to place and manipulate.

AdDent has a long history of producing composite warming technology, with many substantial improvements over the past several decades, including the Calset Composite Warmer (Figure 1). Traditionally, all composite warmers were stand-alone technologies that utilized a warming device to heat composites to 155 °F. These systems heated composite by warming a traditional composite gun preloaded with the selected composite. Although quite effective, once the gun leaves the warming device, the composite begins to lose heat immediately.7 Between each incremental layer of composite, the gun should be returned to the warmer to maintain its temperature at 155 °F. This problem has been eliminated with the creation of AdDent’s Compex HD composite warming gun (Figure 2). This wireless, rechargeable composite gun warms composite in 1 to 2 minutes and can dispense approximately 100 compules before the unit needs to be recharged. The unit is extremely lightweight and possesses an ergonomic design, making composite placement easy and efficient.

Indication and Uses of Compex HD Composite Warming Technology 1

2

3

4

• Warming conventional

composites for all anterior and posterior direct restorations

• Warming flowable

composites for use as a liner in various situations

• Warming flowable and

conventional composites for injection molding techniques

THE SCIENCE OF WARMING COMPOSITE Composite warming was first discussed in literature in the early 1980s.2 These articles discuss the physical properties and changes that occurred with warming composites. From these articles, many clinical techniques were developed using the concept of warming composite.1 Warmed composites have an increase in kinetic energy and great movement compared with room-temperature composites. This phenomenon leads to heated composites experiencing greater monomer conversion and increased depth of cure.3,4 Examination of margin adaptation has demonstrated that heated composites lead to better marginal adaptation than those restorations placed at room temperature.5 Muñoz et al demonstrated that both hybrid and nanohybrids had significantly increased surface hardness and depth of cure when composite heating was utilized.6 Heated composites provide several advantages to clinicians and have the potential to dramatically improve clinical outcomes.

TRADITIONAL COMPOSITE WARMING TECHNOLOGY COMPARED WITH COMPEX HD

• Warming composite resin to

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

be used as a resin cement when placing indirect restorations

5

6

7

8

9

10

11

12

13

14

CATAPULT EDUCATION’S EVALUATION In a recent evaluation of Compex HD with Catapult Education, Compex HD was evaluated by 8 clinical evaluators, 7 of which had extensive experience with composite warming technology and techniques. A total of 100 patients were treated using the Compex HD, with more than 150 restorations being placed. All evaluators (100%) said they would use the Compex HD composite warming device in all restorative and composite procedures, 87% were “very satisfied” with the performance and construction of the warmer, and the remaining 13% were “satisfied” with its performance and construction. The evaluators felt the Compex HD greatly assisted in the placement of composite, making the material far easier to manipulate. AdDent’s Compex HD was awarded the Catapult Education Vote of Confidence, which is a demarcation reserved for only those products that receive overwhelmingly positive reviews and feedback.

CLINICAL CASE This 24-year-old patient presented with fractured incisal edges of #8 and #9, which occurred during a traumatic accident as an adolescent (Figure 3). His desire was to have the incisal edges of his front teeth restored as conservatively as possible without sacrificing an esthetic outcome. With this in mind, the decision was made to utilize a diagnostic wax-up and corresponding incisal edge putty matrix to aid in the placement of Class VI composite resin restorations (Figure 4). Prior to anesthesia and tooth preparation, the putty matrix was tried in to confirm proper seating and fit, and composite shades were selected. Teeth #8 and #9 were prepared using a pointed diamond bur, establishing an irregular bevel along the incisal ¹/3 of each incisor (Figure 5). A Mylar strip was placed in the putty between #8 and #9 to prevent bonding the teeth together. Using the Compex HD, the lingual incisal portion of the putty was loaded with A1 composite (Mosaic; Ultradent Products, Inc) and placed under an orange protective shield. The incisal edges of both incisors were etched with 35% phosphoric acid (Ultra-Etch; Ultradent Products, Inc) (Figure 6). A bonding agent was applied to all etched surfaces and cured with a LED curing light (Figure 7). The preloaded putty matrix was carried to the mouth and placed to deliver the lingual portion of the composite to the prepared teeth. Excess material was cleared from the facial aspect of the restorations to provide room for the enamel veneering composite (Figure 8). This lingual layer of composite was cured using an LED curing light. The lingual matrix was removed, leaving the Mylar strip in place between #8 and #9. Using the Compex HD, Enamel Neutral composite (Mosaic; Ultradent Products, Inc) was placed on the facial aspect of #8 and #9 (Figure 9). The composite was quickly manipulated into place using a composite placement instrument (Figure 10) and cured using an LED curing light (Figure 11). The restorations were then finished using interproximal finishing strips (Figure 12) and polished using the A.S.A.P. polishing system (Clinician’s Choice Dental Products, Inc). The completed restorations (Figures 13 and 14) created a beautiful result and were made simple to place by using the Compex HD by AdDent. References 1.Lopes LCP, Terada RSS, Tsuzuki FM, Giannini M, Hirata R. Heating and preheating of dental restorative materials-a systematic review. Clin Oral Investig. 2020;24(12):4225-4235. doi:10.1007/s00784-020-03637-2 2.Bausch JR, de Lange C, Davidson CL. The influence of temperature on some physical properties of dental composites. J Oral Rehabil. 1981;8(4):309-317. doi:10.1111/j.1365-2842.1981.tb00505.x 3.Daronch M, Rueggeberg FA, De Goes MF, Giudici R. Polymerization kinetics of pre-heated composite. J Dent Res. 2006;85(1):38-43. doi:10.1177/154405910608500106 4.Trujillo M, Newman SM, Stansbury JW. Use of near-IR to monitor the influence of external heating on dental composite photopolymerization. Dent Mater. 2004;20(8):766-777. doi:10.1016/j.dental.2004.02.003 5.Wagner WC, Asku MN, Neme AM, Linger JB, Pink FE, Walker S. Effects of pre-heating resin composite on restoration microleakage. Oper Dent. 2008;33(1):72-78. doi:10.2341/07-41 6.Muñoz CA, Bond PR, Sy-Muñoz J, Tan D, Peterson J. Effect of pre-heating on depth of cure and surface hardness of lightpolymerized resin composites. Am J Dent. 2008;21(4):215-222. 7.Daronch M, Rueggeberg FA, Moss L, de Goes MF. Clinically relevant issues related to preheating composites. J Esthet Restor Dent. 2006;18(6):340-351. doi:10.1111/j.1708-8240.2006.00046.x

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

23

PRODUCT SPOTLIGHT

INNOVATIVE SOLUTIONS

The Next Generation in Composite Warming Technology Compex HD by AdDent, Inc, is awarded Catapult Education’s Vote of Confidence after evaluators test it on 100 patients. by Marc Geissberger, DDS, MA, CPT Published in Dental Products Report, July 1, 2022 Dental Products Report July 2022, Volume 56, Issue 7

W

arming composite to assist clinicians in seating restorations, placing, and manipulating composites has been in regular use since the 1980s.1 AdDent, Inc, has a long history in developing warming technology to improve clinical outcomes and provide a predictable way of effortlessly placing composite restorations.

About Catapult Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.

22

| Fall 2022 |

As composite resin technology has improved with increased strength, higher filler content, lower volumetric shrinkage, and better polishability, composite handling has become more challenging. The improvements made in composite resin technology have produced products that are far stiffer than previous generations, which has created a conundrum for clinicians. Should they continue to use inferior, older technology with easier handling or move to a new composite with dramatically improved characteristics but with significant challenges when placing the restoration because of significantly higher stiffness? Fortunately, the answer does not have to be either one or the other. Clinicians can incorporate composite warming technology and pair that with a modern, nano-filled composite of their choice, which will dramatically lower the viscosity of the composite with higher filler loading, making it easy to place and manipulate.

AdDent has a long history of producing composite warming technology, with many substantial improvements over the past several decades, including the Calset Composite Warmer (Figure 1). Traditionally, all composite warmers were stand-alone technologies that utilized a warming device to heat composites to 155 °F. These systems heated composite by warming a traditional composite gun preloaded with the selected composite. Although quite effective, once the gun leaves the warming device, the composite begins to lose heat immediately.7 Between each incremental layer of composite, the gun should be returned to the warmer to maintain its temperature at 155 °F. This problem has been eliminated with the creation of AdDent’s Compex HD composite warming gun (Figure 2). This wireless, rechargeable composite gun warms composite in 1 to 2 minutes and can dispense approximately 100 compules before the unit needs to be recharged. The unit is extremely lightweight and possesses an ergonomic design, making composite placement easy and efficient.

Indication and Uses of Compex HD Composite Warming Technology 1

2

3

4

• Warming conventional

composites for all anterior and posterior direct restorations

• Warming flowable

composites for use as a liner in various situations

• Warming flowable and

conventional composites for injection molding techniques

THE SCIENCE OF WARMING COMPOSITE Composite warming was first discussed in literature in the early 1980s.2 These articles discuss the physical properties and changes that occurred with warming composites. From these articles, many clinical techniques were developed using the concept of warming composite.1 Warmed composites have an increase in kinetic energy and great movement compared with room-temperature composites. This phenomenon leads to heated composites experiencing greater monomer conversion and increased depth of cure.3,4 Examination of margin adaptation has demonstrated that heated composites lead to better marginal adaptation than those restorations placed at room temperature.5 Muñoz et al demonstrated that both hybrid and nanohybrids had significantly increased surface hardness and depth of cure when composite heating was utilized.6 Heated composites provide several advantages to clinicians and have the potential to dramatically improve clinical outcomes.

TRADITIONAL COMPOSITE WARMING TECHNOLOGY COMPARED WITH COMPEX HD

• Warming composite resin to

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444

be used as a resin cement when placing indirect restorations

5

6

7

8

9

10

11

12

13

14

CATAPULT EDUCATION’S EVALUATION In a recent evaluation of Compex HD with Catapult Education, Compex HD was evaluated by 8 clinical evaluators, 7 of which had extensive experience with composite warming technology and techniques. A total of 100 patients were treated using the Compex HD, with more than 150 restorations being placed. All evaluators (100%) said they would use the Compex HD composite warming device in all restorative and composite procedures, 87% were “very satisfied” with the performance and construction of the warmer, and the remaining 13% were “satisfied” with its performance and construction. The evaluators felt the Compex HD greatly assisted in the placement of composite, making the material far easier to manipulate. AdDent’s Compex HD was awarded the Catapult Education Vote of Confidence, which is a demarcation reserved for only those products that receive overwhelmingly positive reviews and feedback.

CLINICAL CASE This 24-year-old patient presented with fractured incisal edges of #8 and #9, which occurred during a traumatic accident as an adolescent (Figure 3). His desire was to have the incisal edges of his front teeth restored as conservatively as possible without sacrificing an esthetic outcome. With this in mind, the decision was made to utilize a diagnostic wax-up and corresponding incisal edge putty matrix to aid in the placement of Class VI composite resin restorations (Figure 4). Prior to anesthesia and tooth preparation, the putty matrix was tried in to confirm proper seating and fit, and composite shades were selected. Teeth #8 and #9 were prepared using a pointed diamond bur, establishing an irregular bevel along the incisal ¹/3 of each incisor (Figure 5). A Mylar strip was placed in the putty between #8 and #9 to prevent bonding the teeth together. Using the Compex HD, the lingual incisal portion of the putty was loaded with A1 composite (Mosaic; Ultradent Products, Inc) and placed under an orange protective shield. The incisal edges of both incisors were etched with 35% phosphoric acid (Ultra-Etch; Ultradent Products, Inc) (Figure 6). A bonding agent was applied to all etched surfaces and cured with a LED curing light (Figure 7). The preloaded putty matrix was carried to the mouth and placed to deliver the lingual portion of the composite to the prepared teeth. Excess material was cleared from the facial aspect of the restorations to provide room for the enamel veneering composite (Figure 8). This lingual layer of composite was cured using an LED curing light. The lingual matrix was removed, leaving the Mylar strip in place between #8 and #9. Using the Compex HD, Enamel Neutral composite (Mosaic; Ultradent Products, Inc) was placed on the facial aspect of #8 and #9 (Figure 9). The composite was quickly manipulated into place using a composite placement instrument (Figure 10) and cured using an LED curing light (Figure 11). The restorations were then finished using interproximal finishing strips (Figure 12) and polished using the A.S.A.P. polishing system (Clinician’s Choice Dental Products, Inc). The completed restorations (Figures 13 and 14) created a beautiful result and were made simple to place by using the Compex HD by AdDent. References 1.Lopes LCP, Terada RSS, Tsuzuki FM, Giannini M, Hirata R. Heating and preheating of dental restorative materials-a systematic review. Clin Oral Investig. 2020;24(12):4225-4235. doi:10.1007/s00784-020-03637-2 2.Bausch JR, de Lange C, Davidson CL. The influence of temperature on some physical properties of dental composites. J Oral Rehabil. 1981;8(4):309-317. doi:10.1111/j.1365-2842.1981.tb00505.x 3.Daronch M, Rueggeberg FA, De Goes MF, Giudici R. Polymerization kinetics of pre-heated composite. J Dent Res. 2006;85(1):38-43. doi:10.1177/154405910608500106 4.Trujillo M, Newman SM, Stansbury JW. Use of near-IR to monitor the influence of external heating on dental composite photopolymerization. Dent Mater. 2004;20(8):766-777. doi:10.1016/j.dental.2004.02.003 5.Wagner WC, Asku MN, Neme AM, Linger JB, Pink FE, Walker S. Effects of pre-heating resin composite on restoration microleakage. Oper Dent. 2008;33(1):72-78. doi:10.2341/07-41 6.Muñoz CA, Bond PR, Sy-Muñoz J, Tan D, Peterson J. Effect of pre-heating on depth of cure and surface hardness of lightpolymerized resin composites. Am J Dent. 2008;21(4):215-222. 7.Daronch M, Rueggeberg FA, Moss L, de Goes MF. Clinically relevant issues related to preheating composites. J Esthet Restor Dent. 2006;18(6):340-351. doi:10.1111/j.1708-8240.2006.00046.x

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

23

SEPTEMBER - DECEMBER 2022

EDITORS’ CHOICE

Continuing Education Calendar

+++++

There’s More to Explore at

LEADING EDUCATION

clinicalresearchdental.com MAY

What is Hands-On Demand? 24/7 access to world-class continuing education courses which include a comprehensive hands-on technique kit and the opportunity to learn at your own pace in your practice. Once you’ve registered and received your technique kit, you can access your course on your own schedule and you can pause and re-watch the course at any time. All Hands-On Demand courses include 30-day access with unlimited viewing.

Why take an On Demand Course? • Receive a comprehensive hands-on technique kit and technique guide that

are yours to keep

OCT 26

6:30PM - 9:30PM ET

JOSE DA COSTA | BURLINGTON, ON 5-6 Elements of Modern Endodontics - A Modular Approach | Module 2 In-Person Hands-On

3 CE CREDITS

NOV 4

8:30AM - 4:30PM ET

DAVID CLARK | TORONTO, ON Injection Molding and the Bioclear Technique for Composites In-Person Hands-On

6.5 CE CREDITS

NOV 4

8:30AM - 4:30PM ET

MANFRED FRIEDMAN | MONTREAL, QC Problem Solving in Endodontics Including a Fibre Post Hands-On In-Person Hands-On | 6.5 CE CREDITS | 7.5 ODQ UNITS

6.5 CE CREDITS

NOV 5

8:30AM - 4:30PM ET

DAVID CLARK | TORONTO, ON Injection Molding and the Bioclear Technique for Composites In-Person Hands-On

6.5 CE CREDITS

NOV 18

8:30AM - 4:30PM ET

DANIELE LAROSE | MONTREAL, QC Esthetic Composite Restoration on Post-Orthodontic Cases In-Person Hands-On | 6.5 CE CREDITS | 9.5 ODQ UNITS

6.5 CE CREDITS

NOV 18

8:30AM - 4:30PM ET

DENNIS MARANGOS | MISSISSAUGA, ON Practical Pearls for Profitable & Predictable Everyday Dentistry In-Person Hands-On

6.5 CE CREDITS

NOV 23

7:00PM - 8:00PM ET 4:00PM - 5:00PM PT

CARLOS MURGEL | LIVE ON-LINE The Role of Bioceramic Materials in Contemporary Endodontics Complimentary LIVE Demonstration Webinar

NOV 25

8:30AM - 1:30PM ET

IAN RASKIN | NORTH YORK, ON Revolutionizing Your Practice with Lasers In-Person Hands-On

4.5 CE CREDITS

DEC 2

8:30AM - 4:30PM PT

REZA FARSHEY | VANCOUVER, BC Do You Really Know Minimally Invasive Endodontics (MIE)? Hint: It’s not about the ninja access | In-Person Hands-On

6.5 CE CREDITS

DEC 8

6:30PM - 9:30PM MT

SUSAN MCMAHON | CALGARY, AB White Right Now: Current Tooth Whitening Options and Techniques In-Person Hands-On

3 CE CREDITS

• Use Hands-On Demand courses for staff training • 2 CE Credits per course

CURRENT COURSES Manfred Friedman BDS, BChD

Marcos Vargas BDB, DDS, MS

Bob Margeas DDS

Post-Endodontic Restorations: Efficient Void-Free Post & Cores

Esthetic Class lll & Peg Lateral Direct Restoration

Restoring the Discolored Central Incisor

1.5 CE CREDITS | COURSE CODE: MF601

2 CE CREDITS | COURSE CODE: MV401

2 CE CREDITS | COURSE CODE: BM103

1 CE CREDIT

Bob Margeas DDS

Marc Geissberger DDS, MA

DEC 9

8:30AM - 4:30PM MT

SUSAN MCMAHON | CALGARY, AB Conservative Cosmetic Dentistry for Teenagers and Young Adults: Boost their Confidence and Boost your Bottom Line | In-Person Hands-On

6.5 CE CREDITS

Mastering the Class IV Restoration

Freehand Diastema Closure

Mastering the Class ll Restoration

2 CE CREDITS | COURSE CODE: BM101

2 CE CREDITS | COURSE CODE: BM102

2 CE CREDITS | COURSE CODE: MG201

9 DATES

10:00Am - 6:00Pm ET 7:00am - 3:00pm PT

DAVID CLARK | LIVE ON-LINE Injection Molding and The Bioclear Method for Composites Virtual Hands-On Course

7 CE CREDITS

Bob Margeas DDS

David Chan DMD, AAACD

Marc Geissberger DDS, MA

Newton Fahl DDS, MS

Simple Concepts to Shape & Polish Anterior Composites to Rival Porcelain

Beautiful Class V Restorations: Predictable and Simplified

The Direct-Indirect Composite Resin Veneer

2 CE CREDITS | COURSE CODE: DC301

2 CE CREDITS | COURSE CODE: MG202

2 CE CREDITS | COURSE CODE: NF501

EDITORS’ CHOICE

EDITORS’ CHOICE HANDS-ONLINE LIVE Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. 4/1/2021 to 3/31/2023 Provider ID #401651

+++++

+++++

ENROLL TODAY! Visit www.handsonlinelive.com Scan Here to Learn More

www.handsonlinelive.com

Scan here

SEPTEMBER - DECEMBER 2022

EDITORS’ CHOICE

Continuing Education Calendar

+++++

There’s More to Explore at

LEADING EDUCATION

clinicalresearchdental.com MAY

What is Hands-On Demand? 24/7 access to world-class continuing education courses which include a comprehensive hands-on technique kit and the opportunity to learn at your own pace in your practice. Once you’ve registered and received your technique kit, you can access your course on your own schedule and you can pause and re-watch the course at any time. All Hands-On Demand courses include 30-day access with unlimited viewing.

Why take an On Demand Course? • Receive a comprehensive hands-on technique kit and technique guide that

are yours to keep

OCT 26

6:30PM - 9:30PM ET

JOSE DA COSTA | BURLINGTON, ON 5-6 Elements of Modern Endodontics - A Modular Approach | Module 2 In-Person Hands-On

3 CE CREDITS

NOV 4

8:30AM - 4:30PM ET

DAVID CLARK | TORONTO, ON Injection Molding and the Bioclear Technique for Composites In-Person Hands-On

6.5 CE CREDITS

NOV 4

8:30AM - 4:30PM ET

MANFRED FRIEDMAN | MONTREAL, QC Problem Solving in Endodontics Including a Fibre Post Hands-On In-Person Hands-On | 6.5 CE CREDITS | 7.5 ODQ UNITS

6.5 CE CREDITS

NOV 5

8:30AM - 4:30PM ET

DAVID CLARK | TORONTO, ON Injection Molding and the Bioclear Technique for Composites In-Person Hands-On

6.5 CE CREDITS

NOV 18

8:30AM - 4:30PM ET

DANIELE LAROSE | MONTREAL, QC Esthetic Composite Restoration on Post-Orthodontic Cases In-Person Hands-On | 6.5 CE CREDITS | 9.5 ODQ UNITS

6.5 CE CREDITS

NOV 18

8:30AM - 4:30PM ET

DENNIS MARANGOS | MISSISSAUGA, ON Practical Pearls for Profitable & Predictable Everyday Dentistry In-Person Hands-On

6.5 CE CREDITS

NOV 23

7:00PM - 8:00PM ET 4:00PM - 5:00PM PT

CARLOS MURGEL | LIVE ON-LINE The Role of Bioceramic Materials in Contemporary Endodontics Complimentary LIVE Demonstration Webinar

NOV 25

8:30AM - 1:30PM ET

IAN RASKIN | NORTH YORK, ON Revolutionizing Your Practice with Lasers In-Person Hands-On

4.5 CE CREDITS

DEC 2

8:30AM - 4:30PM PT

REZA FARSHEY | VANCOUVER, BC Do You Really Know Minimally Invasive Endodontics (MIE)? Hint: It’s not about the ninja access | In-Person Hands-On

6.5 CE CREDITS

DEC 8

6:30PM - 9:30PM MT

SUSAN MCMAHON | CALGARY, AB White Right Now: Current Tooth Whitening Options and Techniques In-Person Hands-On

3 CE CREDITS

• Use Hands-On Demand courses for staff training • 2 CE Credits per course

CURRENT COURSES Manfred Friedman BDS, BChD

Marcos Vargas BDB, DDS, MS

Bob Margeas DDS

Post-Endodontic Restorations: Efficient Void-Free Post & Cores

Esthetic Class lll & Peg Lateral Direct Restoration

Restoring the Discolored Central Incisor

1.5 CE CREDITS | COURSE CODE: MF601

2 CE CREDITS | COURSE CODE: MV401

2 CE CREDITS | COURSE CODE: BM103

1 CE CREDIT

Bob Margeas DDS

Marc Geissberger DDS, MA

DEC 9

8:30AM - 4:30PM MT

SUSAN MCMAHON | CALGARY, AB Conservative Cosmetic Dentistry for Teenagers and Young Adults: Boost their Confidence and Boost your Bottom Line | In-Person Hands-On

6.5 CE CREDITS

Mastering the Class IV Restoration

Freehand Diastema Closure

Mastering the Class ll Restoration

2 CE CREDITS | COURSE CODE: BM101

2 CE CREDITS | COURSE CODE: BM102

2 CE CREDITS | COURSE CODE: MG201

9 DATES

10:00Am - 6:00Pm ET 7:00am - 3:00pm PT

DAVID CLARK | LIVE ON-LINE Injection Molding and The Bioclear Method for Composites Virtual Hands-On Course

7 CE CREDITS

Bob Margeas DDS

David Chan DMD, AAACD

Marc Geissberger DDS, MA

Newton Fahl DDS, MS

Simple Concepts to Shape & Polish Anterior Composites to Rival Porcelain

Beautiful Class V Restorations: Predictable and Simplified

The Direct-Indirect Composite Resin Veneer

2 CE CREDITS | COURSE CODE: DC301

2 CE CREDITS | COURSE CODE: MG202

2 CE CREDITS | COURSE CODE: NF501

EDITORS’ CHOICE

EDITORS’ CHOICE HANDS-ONLINE LIVE Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. 4/1/2021 to 3/31/2023 Provider ID #401651

+++++

+++++

ENROLL TODAY! Visit www.handsonlinelive.com Scan Here to Learn More

www.handsonlinelive.com

Scan here

NEW PRODUCT SHOWCASE

INNOVATIVE SOLUTIONS NEW RESOURCES

TrollFoil®

Articulating Foil

NEW!

The Gold Standard for Every Dentist! TrollFoil® Articulating Foil from TrollDental is the thinnest articulating product on the market. Clinical Research Dental exclusively sells the TrollFoil 4.5 Micron variation across Canada.* Research shows that the thinner the articulating foil, the better. Thick articulating paper generates a less uniform and larger occlusal contact area than the occlusal area marked with thin articulating foil. TrollFoil 4.5 is double-sided blue colour mounted on its own frame eliminating the need for forceps. Marks on wet, dry, and highly polished surfaces, at 4.5 microns thick this super-thin foil gives you very precise markings. 4.5 Micron Blue 80-Pack 208319 8 Micron Blue 100-Pack 208318 8 Micron Blue 500-Pack 208320 8 Micron Red 100-Pack 208323

*Clinical Research Dental also sells TrollFoil in 8 Micron variations as well.

Scan to shop Scan QR code or visit: the Clinican's www.clinicalresearchdental.com Choice collection tofree download or view. The item should be of equal or lesser value.

NEW!

Spotit®

C&B Contact Finder Faster, More Accurate Provisionals. Spotit® C&B Contact Finder from TrollDental is a coloured marker available in straight and angled handle. As the marker traverses the contact between the prosthetic element and the adjacent tooth it leaves a clear and accurate indication of the adjustment needed for a perfect contact point. The whole operation can be performed without assistance - holding the crown with one hand and the marker with the other hand. Adjusting contact points on crowns and bridges has never been easier!

Scan QR code or visit: www.clinicalresearchdental.com to download or view.

Scan to shop the Bioclear Method collection

Assorted 18-Pack SAVE XX XX 208322 Angled 18-Pack Refills XX $XX Reg. $XX XX208321

NEW!

Compex HD™

Thermal Assisted Composite Dispenser The ease, convenience, and comfort of Compex HD make it a must have for your practice. For optimum temperature, all the benefits of heated delivery, Compex HD delivers the perfect flow for all restorative procedures including injection molding and porcelain cementation. Compex HD heats all compules to 155˚F (68˚C) in 1-2 minutes. Up to 100 compules can be dispensed without recharging. This all-in-one, light weight, heated dispenser saves space and easily moves from room to room. Fast compule insertion saves time and are easy to eject when doing multiple restorations or layering. Infection control is addressed with included autoclavable silicone sleeves and barrier bags that prevent cross contamination.

Scan QR code or visit: www.clinicalresearchdental.com to download or view. 436120

Scan to shop the Ultradent collection

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

27

NEW PRODUCT SHOWCASE

INNOVATIVE SOLUTIONS NEW RESOURCES

TrollFoil®

Articulating Foil

NEW!

The Gold Standard for Every Dentist! TrollFoil® Articulating Foil from TrollDental is the thinnest articulating product on the market. Clinical Research Dental exclusively sells the TrollFoil 4.5 Micron variation across Canada.* Research shows that the thinner the articulating foil, the better. Thick articulating paper generates a less uniform and larger occlusal contact area than the occlusal area marked with thin articulating foil. TrollFoil 4.5 is double-sided blue colour mounted on its own frame eliminating the need for forceps. Marks on wet, dry, and highly polished surfaces, at 4.5 microns thick this super-thin foil gives you very precise markings. 4.5 Micron Blue 80-Pack 208319 8 Micron Blue 100-Pack 208318 8 Micron Blue 500-Pack 208320 8 Micron Red 100-Pack 208323

*Clinical Research Dental also sells TrollFoil in 8 Micron variations as well.

Scan to shop Scan QR code or visit: the Clinican's www.clinicalresearchdental.com Choice collection tofree download or view. The item should be of equal or lesser value.

NEW!

Spotit®

C&B Contact Finder Faster, More Accurate Provisionals. Spotit® C&B Contact Finder from TrollDental is a coloured marker available in straight and angled handle. As the marker traverses the contact between the prosthetic element and the adjacent tooth it leaves a clear and accurate indication of the adjustment needed for a perfect contact point. The whole operation can be performed without assistance - holding the crown with one hand and the marker with the other hand. Adjusting contact points on crowns and bridges has never been easier!

Scan QR code or visit: www.clinicalresearchdental.com to download or view.

Scan to shop the Bioclear Method collection

Assorted 18-Pack SAVE XX XX 208322 Angled 18-Pack Refills XX $XX Reg. $XX XX208321

NEW!

Compex HD™

Thermal Assisted Composite Dispenser The ease, convenience, and comfort of Compex HD make it a must have for your practice. For optimum temperature, all the benefits of heated delivery, Compex HD delivers the perfect flow for all restorative procedures including injection molding and porcelain cementation. Compex HD heats all compules to 155˚F (68˚C) in 1-2 minutes. Up to 100 compules can be dispensed without recharging. This all-in-one, light weight, heated dispenser saves space and easily moves from room to room. Fast compule insertion saves time and are easy to eject when doing multiple restorations or layering. Infection control is addressed with included autoclavable silicone sleeves and barrier bags that prevent cross contamination.

Scan QR code or visit: www.clinicalresearchdental.com to download or view. 436120

Scan to shop the Ultradent collection

CLINICAL LIFE | clinicalresearchdental.com | 1-800-265-3444 |

27

Learn Dental Conference

Stay

☼ 3 Mornings of Lectures ☼ 12 CE Hours/Credits

February 2 - 4, 2023

Play

Betsy Bakeman, DDS, FAACD

William “Bo” Bruce, DMD, AAACD

Susan McMahon, DDS, AAACD, FAGD

David Chan, DMD, AAACD

Amanda Seay, DDS, FAACD

Adamo Notarantonio, DDS, FICOI, FAACD

INDUSTRY-RENOWNED SPEAKERS, WORLD-CLASS RESORT

Register Early & Save Early Registration:

$1,795*

*if you register on or before November 30, 2022 For Group Rates please contact us at 1-800-265-3444 ext. 223

Dentist Tuition: $1,995 Staff: $895 To learn more visit arubadentalconference.com

P.O. Box 28040 | London, ON | Canada | N6H 5E1