Testing the Tools

By Ross Isbell, DMD, MBA

Go with the GLO

GLO® Whitening

GlO Science Professional

glosciencepro.com

As I’m sure is the case for most general dental offices, we always have a whitening product as part of our available services. Our preferred brand was Phillips Zoom for in-office treatment, and we made custom whitening trays to allow for at-home whitening with Opalesence™ from Ultradent™ to maintain the results. Those are great products, but all the work that went into provision of the service just felt cumbersome, and our results weren’t always predictable or comfortable for patients. About a year ago, we swapped to the GLO® whitening system, and it is so much simpler to deliver similar results on the day of treatment and better long-term results. This system is designed to be a dual-whitening system and combines in-office treatment with take-home whitening kits. Using hydrogen peroxide with a double-barreled delivery syringe, the in-office treatment is strong enough at 30% to cause tissue damage unless gingival blockout is applied. However, this proprietary gel mixture, when paired with the closed mouthpiece system, doesn’t require lengthy treatment times and results in significantly less reported sensitivity. The closed mouthpiece I am referencing applies to both the single-use one that we use in the office as well as the reusable one that the patient takes home. It is important to note that it is a closed system because a tightly conforming fit is critical to prevent oxygen-free radicals from escaping after they are activated by the gentle heat and light. You must also limit the introduction of peroxidases from saliva. By maintaining an efficacious level of functioning hydrogen peroxide byproducts for a longer period, the concentration is lower (many other products use 35%) and treatment cycle times are shorter (eight minutes compared to 30) than competitors. Since in-office whitening alone can lose its effects after a week, it is important that your patients commit to continuing the process. Assuming that you have good patient compliance with the at-home regimen of 16 minutes per day for four days, the shade change results actually amplify over time while not having adverse effects. In our office, we recommend a cleaning — or at least a prophy polishing with pumice only and no bioactive materials like fluoride — prior to treatment to remove extrinsic staining and biofilm. Then, we place the included retractors for initial placement of the gingival block-out resin. The gel is painted directly onto the teeth prior to placement of the mouthpiece. Don’t forget to preheat the mouthpiece since heat is important for the whitening reaction. Cycles last for eight minutes each prior to swapping out the gel. Most patients stop after three cycles due to time constraints, but the kits allow for up to five. Usually, we schedule these appointments as two-hour time blocks for a standalone whitening, but that is to allow for conversation, pre-op photography and pumicing. If scheduled appropriately, this can be completed as a one-hour appointment or less after a hygiene visit. Since we began using the system, GLO has partnered with vVardis to increase rebuilding of healthy enamel mineral structure after removal of intrinsic staining. The GLO whitening system transition has been an easy one for my team, and we are having better and easier results along with decreased chair time.

A Royally Good Crown Remover

Max Crown Spreader™

Artcraft Dental, Inc.

artcraftdental.com

Crown removal processes and instruments that aren’t lasers are all fairly standard in their shape, typically a flatter and more reinforced version of an eleva tor. There are some notable exceptions, such as WAMkey® by GoldenDent most utilize an average shape with different handles or materials. The Max Crown Spreader™ from Artcraft Dental takes the idea of leveraging with a flat surface and offers it in all three dimensions instead of just one. It has a cross-shaped tip that is off-angled from the axis of its long handle but also has the fins of the cross extending farther down the shank. This extended fin design allows for establishing a purchase point from a wide variety of angles, which can be useful in separating crown fragments from coronal tooth structure after sectioning. Artcraft sells two burs, one carbide and one diamond, designed and sized specifically to optimize the use of the Max Spreader. I use its burs sometimes, but I more often utilize a crown prep diamond size 16 or 25 or a crosscut 557. Most of my crown prep burs have a chamfer tip, so, after initial sectioning, I sometimes need to go back for another pass with a flat-ended bur to eliminate the chamfer curve. This will create a flatter butt joint to allow for a greater force to be exerted in the crown when torquing the Max Spreader. If sectioning a porcelain-fused-to-metal crown, I prefer to leave about 1 millimeter of the metal margin intact on one side of the crown so that I can hopefully remove it in one piece. But for all-ceramic restorations, I usually just prep all the way through to minimize my fight. This has become my go-to instrument for crown removals, and, if you are looking to restock or upgrade, you will find this to be a highly predictable tool for crown removals.

Score a Touchdown with this Football

OccluShaper 370

Komet

kometusa.com

My philosophy on crown prepping continues to shift through my practice career, and, with it, the burs that I use more quickly adapt to these new styles. My current occlusal reduction process starts with depth cutting burs, either a 1.5- or 2.0-millimeter depth, then I use a coarse football to eliminate remaining vertical ridges. After decay removal, a circumferential prep (if needed) and buildup of core structures, I was using a standard-shaped red or yellow diamond football to finish the occlusal prep until I stumbled across the OccluShaper 370 from Komet. Now, this is my preferred bur for occlusal reduction and shaping after depth cuts. This bur comes in a coarse or fine grit and in both premolar and molar sizes. I am currently only using the molar-size red stripe diamond because I like having a regular football on my standard block for other applications. Unique from a standard ovoid football design, the diamond coating extends in a prolate direction outward from the ovate center in a smooth parabolic curve until it approaches the center of the axis of the bur and remains about 0.5 mm thick. Since the diamonds extend about 10 mm from one end to the other, you can simply set the bur on the occlusal surface and move it in a mesiodistal direction until you have achieved your desired reduction while simultaneously creating ideal anatomy. Since all-ceramic restorations require smooth and rounded contours to minimize fractures of the monolithic crystalline structure, this bur set is perfectly designed for ideal shaping. Komet also offers a comprehensive onlay kit that includes prep burs and others that work well for a minimally invasive preparation technique. The other burs in the kit are similar to what I already used, so I haven’t chosen to swap any others, but the OccluShaper is a true game-changer and will quickly earn a place of honor on your personal block.

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.