7 minute read
Testing the Tools
By Ross Isbell, DMD, MBA
Mints That Will Literally Make Your Mouth Water
Flintts Mints
Flintts
flintts.com
Dry mouth products in the pharmacy dental aisle have been the same for decades, and they have been lacking energy and excitement just as long. Flintts Mints are an interesting addition, and they should be part of your recommended salivary induction therapies. They are shaped like circular flowers and come in slim, brightly colored metal boxes that easily fit in a pocket or clutch. Of the sampler pack I tried, my flavor ranking is: strawberry, cherry, grape, lemon then mint. Overall, I significantly preferred the fruity flavors over the mint. There is some sweetness to the mints due to isomalt and sucralose, which are nonfermentable artificial sugar substitutes that oral bacteria aren’t able to easily metabolize, which should help reduce plaque formation compared with regular mints that contain sugar. Magnesium stearate is the binding agent that combines the powder of various plant extracts, the most important of which is spilanthes. Spilanthes is supposedly able to numb, reduce inflammation and help heal ulcers. The mints produce a tingling sensation at varying intensities in the area you place them depending on the product. Though I could not find an absolute measurement system, the company uses a relative labeling system that lists these as different “F strengths,” ranging from 100 to 300. I tried placing the mints in multiple locations around the buccal vestibule and sublingual to see if there was a difference. I found that placing one on the cheek near the parotid papilla is most effective. Repeated placement under the tongue caused roughness and ulceration, whereas placing them in the buccal corridor didn’t cause a physical change in my tissue. Only one mint is needed to produce increased salivation, especially with the higher strengths, but, for maximum stimulation, a mint could be placed bilaterally and sublingually in areas near each major gland group location. Using the mints as lozenges will result in about 30 minutes of effectiveness, while chewing makes the effect more intense, but only lasts about five minutes. This is an interesting adjunctive product for dry mouth patients to feel some relief with a nice variety of flavorings.
Picking Up Good Vibrations
Dental Pod
Zima Dental
zimadental.co
Ultrasonic cleaning methods have been used in dentistry for a long time as part of instrument sterilization processes for debris removal, but the units are large and quite noisy. In my practice, we were searching for a way to make an ultrasonic bath part of our zirconia bonding process, so we started to look for smaller bath sizes and found the Dental Pod from Zima Dental. The Dental Pod has been a helpful and easily moveable tool, cleaning devices in individual operatories. It typically uses 42,000-hertz ultrasonic waves to vibrate whatever solution is placed in the container, producing nanobubbles in the Pod. This vibration, or cavitation, and bubble formation does not cause physical damage to objects, but it is effective at separating objects or devices from debris and plaque. A standard cleaning entails approximately 4,000 vibrations per second through a five-minute cycle. Depending on the amount of water and weight in the Pod, it will adjust the frequency to optimize the cleaning effect. At just over four inches in diameter, it can contain a single arch of most appliance types, such as clear aligners, mouth guards and dentures. The volume of fluid contained is 150 milliliters (about five fluid ounces). It is also effective at cleaning jewelry, handpiece burs or crowns. The sanitary tablets sold with the product contain sodium bicarbonate as well as sodium carbonate peroxide, citric acid and flavorings to create a clean taste and smell while not being corrosive to metal. Since I use this in my practice, I take measures to maintain a more sanitary environment, such as wiping the interior after use and using a plastic bag as a liner. The Dental Pod is sold for $99.99, so it is not as big an investment as a sterilization unit. For zirconia bonding, I place crown or bridge units prior to sandblasting in an alcohol solution after try-in and treatment with Zirclean or Ivoclean. The Dental Pod is a small and easy upgrade for a hygiene or prosthetic operatory — or for your personal bathroom.
Be Particular About Your Particles
Ivoclean
Ivoclar
ivoclar.com
A crucial step in achieving a high bond strength is effective cleaning of the intaglio surface of zirconia and lithium disilicate restorations. One of the market leaders in that category is Ivoclean from Ivoclar. This pinky purplish suspension of water and zirconium oxide particles is highly effective at removing phosphate groups leftover from salivary phospholipid contamination. This works due to a chemical equilibrium reaction when a concentration gradient of more abundantly available zirconium particles is reached in an alkaline pH of about 13 to facilitate detachment from the restoration surface and attachment to the free-floating particles of the solution. Sodium hypochlorite is also effective at cleaning surfaces, but it doesn’t actively remove phosphate groups. Phosphate group aggregation only increases with exposure to phosphoric acid from a traditional etch, and etching with hydrofluoric acid on an already etched restoration could result in a weakened structure. So, using an atraumatic cleaning solution like Ivoclean is critical to a strong and strongly bonded prosthetic. After removing the adjusted restoration from the oral cavity, simply paint or coat the intaglio surface for 20 seconds with Ivoclean using a clean microbrush to agitate while treating. Then rinse with water for 20 seconds over a 2.25-inch Coghlan’s filter funnel attached to the highvolume suction. Air-dry for 20 seconds. After the surface is cleaned, I sandblast and then treat the surface with a methacryloxydecyl dihydrogen phosphate (MDP) primer like Monobond Plus prior to delivering with a bonding agent and an adhesive resin cement. The Ivoclean bottle contains five grams, which is typically enough doses for about 50 restorations, so it effectively costs about $1 or less per use. Since this is a solution, make sure to shake it if you aren’t using it often, but I typically see very little separation in the appearance of the liquid. Remember, if you try the restoration into the mouth again after Ivoclean treatment, you must redo the treatment since the phosphate groups have reattached. While it is understandably annoying to add steps to your process, including a surface treatment by Ivoclean will enhance your bond strength and the lifetime of your restorations.
Here is the Isbell Dental zirconia bonding process:
Try in and adjust until the fit is good and confirmed with radiograph.
Rinse with water to remove blood or other debris.
Apply cleaning agent, such as Zirclean or Ivoclean.
Perform alcohol bath in ultrasonic cleaning device.
Sandblast with alumina oxide.
Apply MDP primer, such as Z-plus or Monobond Plus, to intaglio surface.
Treat prep with universal bonding agent.
Fill intaglio with resin cement and deliver.
Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org.
