Issuu

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

MAY / JUNE 2021

20 - 35

58 - 72

41 - 52

ENDODONTIC SOLUTIONS

INFECTION CONTROL SOLUTIONS

PAEDIATRIC SOLUTIONS

INDEX Our Solutions 3D Printing Solutions

92-93

3Shape 87-89

Hu-friedy

CAD CAM Solutions

90-91

Adec 82-85

Invisalign Go

4-19

Ansell 52

Itero 86

Digital Solutions

86-89

AquaCare 7

Kavo 82-85

Endodontic Solutions

20-35

Asiga 92-93

Komet

Equipment Solutions

80-85

BL 34

Kuraray Noritake

Handpiece & Instruments

78-79

Busa 35

Mocom 44-45

Handpiece Solutions

76-77

Cattani 80-81

Morita

Infection Control Solutions

41-52

Colgate

54-57, 60-83

Ozdent 28-30

Instrument Solutions

73-75

Coltene

14-19, 24-27

Planmeca 82-85

New Products

95-99

Dentisan 42-43

SciCan 48-49

Durr Dental

Cosmetic & Restorative

60-51, 70-75, 78-79 40

12, 31-33 8-11, 66-67

22-23, 76-77, 82-85

80-81

Septodont 36-39

Pain Control

36-39

EdgeEndo 20-21

Sherman 64-65

Paediatrics Solutions

58-72

The Wand

Orthodontic Solutions

Our Brands

4-6, 53, 58-59

68-69

Practice Management Solutions 94

GKE 46-47

Vita 90-91

Preventative Solutions

Henry Schein One

White Dental Beauty 13

53-57

80 - 85

EQUIPMENT SOLUTIONS

86 - 89

73 - 75

INSTRUMENT SOLUTIONS

DIGITAL SOLUTIONS

WELCOME Henry Schein’s mission is to continually improve the lives of all Australians by focusing on practice care, so yourselves as dental professionals can focus on patient care. A key way we achieve this is to partner with global leading manufacturers and suppliers to source the highest quality products for you and your practice. The relationship with suppliers forms on of the five key constituents of our Mosaic of Success, priding ourselves in bringing our supplier partners and customers closer together, and as a result Henry Schein has proudly introduce and establish hundreds of brands and tens of thousands of products and ranges to the Australian dental market. In this edition you can read articles from many of our market leading suppliers, including our special focus on Paediatric dentistry with a selection of articles on key products to help both the practitioner and the patient in the most important part of their dental life.

with GC ran 11 clinical webinars throughout the month of March. To support our aim of bringing suppliers and customers closer together you can get access these webinars plus over 150 others completely free and on demand at DentalEducationHub.com.au

2021 marks a milestone year for some of our supplier partners. In April GC celebrated 100 years in Dental, and to commemorate this Henry Schein in partnership

We look forward to meeting many of you in person at ADX Melbourne on 6-8th May.

In addition to this Colgate, Vita, Planmeca all have key milestones to celebrate this year amongst others. It is truly exciting times to partner with these key suppliers. As we continue to improve each edition of the Dental Solutions, we would love to hear from you; please email: feedback@henryschein.com.au

ONLINE

TV MADALEINE PAYNE National Strategic Partnerships Manager

h en r y sc h e i n .c o m .a u

COSMETIC & RESTORATIVE

PROTECTING ROOT SURFACES WITH GC FUJI® VII / VII EP

With an ageing population, root surface caries and cervical erosion have become a daily challenge. Once exposed to the oral environment, root surfaces are at greater risk of demineralisation, especially when patients have reduced saliva flow and diminished buffering capabilities.

3 reasons why exposed root surfaces are at high risk of dental problems: 1. Exposed dentine tubules: Higher incidence of cervical sensitivity is observed, especially if saliva quality and quantity is reduced. 2. Lower acid resistance: Exposed root surfaces are much more susceptible than enamel to acid attack and demineralisation. 3. Plaque trap: The exposed CEJ (Cementum Enamel Junction) is a rough plaque trap that rings the root of a tooth.

Apply GC Fuji VII EP GC Fuji VII EP is a clinically proven glass ionomer cement, further enhanced with RECALDENT® (CPP-ACP) for optimum protection of exposed root surfaces in high caries risk patients, including those with: • • • •

Reduced saliva flow High acid exposure Compromised cleaning and plaque removal capability Reduced treatment compliance (less frequent attendance of recall visits and/or non-compliant with home care preventive treatment)

Patient presents with an exposed root surface on a canine

The plaque was gently removed

CAVITY CONDITIONER applied for 10 sec

GC Fuji VII EP white was applied

Application of EQUIA Forte Coat (light-cured 20 sec)

Completed Fuji VII EP root surface protection

COSMETIC & RESTORATIVE

EVERSTICK FIBRES PATIENT-FRIENDLY AND MINIMALLY INVASIVE

everStick fibres open up new opportunities for patient-friendly, minimally invasive procedures and restorations.

The cost-effective, immediate bridge solution The use of everStick C&B fibre reinforcement offers a unique treatment method for replacing missing teeth. With everStick C&B, you can prepare composite bridges, reinforced with fibres, in one single visit using a minimally invasive technique. This evidence based fibre reinforcement technology provides you with a metal-free, cost-effective yet highly aesthetic treatment choice.

Replacement of a missing tooth in one session with a direct bonding approach everStick C&B is suitable for full bridge preparations and surface retained adhesive bridges, in both anterior and posterior situations.

All images courtesy of Prof M Peumans, Belgium

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

INVISALIGN & GC INJECTABLE RESIN INVISALIGN CLINICAL

Invisalign is an exciting development that was introduced into the market in 1998 as an alternative to fixed appliances. Prior to starting treatment with the first aligner, composite keys are placed on certain teeth in the mouth. These composite keys, known as attachments, provide the additional forces or retention required to move the teeth to their designated position. Invisalign and G-ænial Universal Flo

G-ænial Universal Flo and G-ænial Universal Injectable are both high strength injectable composite resin. G-ænial Universal Flo from GC was released in 2011 as the first universal application, high strength flowable composite resin. It has been ideal for creating Invisalign attachments with excellent clinical outcomes (exceptional aesthetics, no flash, ideal flow without being runny, high strength and no porosities) and most importantly a significant reduction in application time helping further improve the cost effectiveness of the Invisalign treatment procedure.

4. G-ænial Universal Flo

4.G-aenial Universal flo

2. Teeth are cleaned with pumice, then etched with phosphoric acid for 30 secs, wash and dry.

and dry.

3. Apply G-Premio BOND, leave 5-10 secs, dry with MAXIMUM air for 5 sec's. Light cure for 10 secs.

3.Apply G-Bond, leave 5-10 sec’s, dry with MAXIMUM air for 5 sec’s. Light cure for 10 secs.

2. Teeth are cleaned with pumice, then etched with phosphoric acid for 30 secs, wash and dry. 5. G-aenial Universal Flo, shade AE is used to fill the attachment space in the template.

5. G-ænial Universal Flo, shade AE, is used to fill the attachment space in the template. Application is controlled 7 .Attachments in position, following template removal. to avoid overfilling.

5. G-aenial Universal Flo, shade AE is used to fill the attachment space in the template. Application is controlled to avoid overfilling.

Application is controlled to avoid overfilling.

6. Once the template is placed in the mouth, the composite is light cured for 20 seconds, the template is then removed.

3.Apply G-Bond, leave 5-10 sec’s, dry with MAXIMUM air for 5 sec’s. Light cure for 10 secs.

6. Once the template is placed in the mouth, the composite is light cured for 20 seconds, the template is then removed.

7 .Attachments in position, following template removal.

7. Attachments in position, following template removal.

8. Excess flash is removed with a tungsten carbide bur.

9. Completed Invisalign attachments after final polishing.

9. Completed Invisilign attachments after final polishing.

Images courtesy of Dr Anthony Mak, Sydney NSW

1. Invisalign attachment template

1. Invisilign attachment template

These are ideal for creating Invisalign attachments with excellent clinical outcomes (exceptional aesthetics, no flash, ideal flow without being runny, high strength and no porosities) and most importantly a significant reduction in application time helping further improve the cost effectiveness of the 2. Teeth are cleaned with pumice, then etched with phosphoric acid for 30 secs, wash Invisalign treatment procedure.

COSMETIC & RESTORATIVE

RESTORATION WITH AQUACARE

Restoration with AquaCare by Lincoln Harris “The dentine margin needs to finish at 90 degrees. Enamel can have infinite finish lines with composite, but dentine cannot. It places too much stress on the bond and as the dentine deteriorates, you get staining up under the composite. If you have to finish on dentine, its better to have a margin. Any demineralised enamel needs to be chased. Composite that finishes on demineralised enamel gets staining quickly. I did not remove the deepest part of the previous resin on the lateral. Air abrasion from buccal and lingual to remove all debris. I use an AquaCare.”

Hypo-mineralised with AquaCare by Thomas Taha UK

Before

After

“Used AquaCare 53μm micron Aluminium Oxide cutting powder to remove fractured and decayed hypo mineralised tooth tissue only without the need for drilling.”

DR THOMAS TAHA BDS United Kingdom h en r y sc h e i n .c o m .a u

DR LINCOLN HARRIS BDS Australia 7

COSMETIC & RESTORATIVE

40 YEARS OF MDP WHAT IF KURARAY NORITAKE HAD NOT DEVELOPED THE MDP MONOMER?

What would the quality of adhesive dentistry be if Kuraray Noritake had not developed the MDP monomer in 1981? MDP has proved to be a very effective functional monomer for creating durable bonding to enamel, dentine and metals. The best-known products containing MDP are CLEARFIL™ SE BOND and PANAVIA™. Adhesion to various substrates is possible thanks to MDP (methacryloyloxydecyl dihydrogen phosphate), which has been shown to create a long term, durable and stable bond to both dental tissue and metal oxides. Research conducted over the past few decades has demonstrated the effectiveness of MDP. The first Kuraray Noritake Dental product to contain MDP was PANAVIA EX. Various other adhesive and cementation systems followed. Our latest products, PANAVIA™ V5 and CLEARFIL™ Universal Bond, also rely to a large extent on the performance of the original MDP monomer. MDP has the following structure:

developments. The solid ionic bond with calcium from the HAp in dental tissue means that such failures as occur are cohesive in the dentine rather than being failures of the adhesive. Apart from in vitro studies confirming this bond strength, the long term clinical durability recorded over 13 years is also impressive.

1. terminal double bond group for polymerisation 2. hydrophobic alkylene group to maintain a delicate balance between hydrophobic and hydrophilic properties and 3. hydrophilic phosphate group for performance of the acid demineralisation and chemical bonding to tooth structure. History In the years between 1978 and the late 1990s, it became possible to increase the bond strength to dentine to more than the intrinsic strength of the dentine itself. MDP played a major role in these

Structure of Adhesive monomer MDP

COSMETIC & RESTORATIVE

Research

µTBS of MDP’s from different origin

Research from Yaun et al., 2007, shows that defects along the interface are largely responsible for degradation of the hybrid layer. CLEARFIL™ SE BOND exhibited no such defects. So, it was expected that SE BOND would also prove to have a stable connection to dental tissue. Peumans et al. from Leuven University, Belgium found CLEARFILTM SE BOND to still have excellent clinical effectiveness after 13 years.

Yoshihara K et al. Functional monomer impurity affects adhesive performance Dent Mater 31, 1493-1501, 2015

In their publication in the Journal of Dental Research 83, 2004, Yoshida et al. concluded that the choice of the adhesive monomer played a significant role in the effectiveness of the adhesive. They found MDP to be the best and fastest in tests for chemical adhesion (ionic bonding) and stability in a moist environment (insoluble) – better and more stable than 4-MET and Phenyl-P, in that order. Kumiko Yoshihara et al. published ‘Functional monomer impurity affects adhesive performance’, in Dental Materials 31 (2015) 1493-1501. They concluded that the three MDP’s they studied exhibited different levels of purity. Differences in the resultant hybrid layers were observed in all three MDP versions: both impurities and the presence of dimers had an effect on the etching efficacy of the HAp, and also on the intensity of nano-layer presence and the immediate bond strength.

Figure 2: µTBS of MDP’s from different origin

Explanation The three 10-MDP’s studied in this study clearly revealed a different purity. Differences in the ultrastructure of the resultant hybrid layers were observed for the three 10-MDP versions. Both the impurities and the presence of dimers affected the etching efficacy of HAp, the intensity of nanolayering and the ‘immediate’ bond strength.

After 40 years, MDP is still in a class of its own. To date, no manufacturer has been able to develop an adhesive monomer with better adhesion properties combined with durable bond strength. Many attempts have been made, but none have succeeded. In the meantime, Kuraray’s patent on MDP has expired. This has opened up the market for other manufacturers to synthesise their own MDP. Only a few non-dental chemical companies are supplying MDP to other manufacturers of adhesive systems, and the synthesis of high-purity MDP remains extremely difficult.

1 3 0 0

Quote

The purity of 10-MDP present in commercial dental primers, adhesives and cements can be expected to influence bonding perfomance.

6 5

8 8

2 2

COSMETIC & RESTORATIVE

KEY PROPERTIES OF MODERN ONE-STEP BONDING AGENTS AN INTERVIEW WITH DR TOMOHIRO TAKAGAKI

DDS PHD

Due to its increased usability, one-step universal adhesives are becoming more popular and the choice of many clinicians all around the world. Nonetheless, some studies have shown a lower performance than previous generations. Jorge Espigares, DDS, PhD, Planning and Development Department at Kuraray Noritake Dental, interviewed Tomohiro Takagaki, DDS, PhD, lecturer and former assistant professor at Tokyo Medical and Dental University (TMDU), pioneer in the field adhesive dentistry, author of many publications and currently lecturer at Asahi University.

Dr. Espigares: Dr. Takagaki, in your opinion, what are the most important factors for a good and durable adhesion? Dr. Takagaki: Good resin infiltration (penetration) and good polymerisation are essential factors for good bonding. This is the basic concept for the formation of the hybrid layer. Additionally, there are other important factors such as low water sorption for bonding durability and the demineralization depth, which should be the same as the depth that the resin is capable of penetrating to. Dr. Espigares: Nowadays, the trend seems to be one-step universal adhesives. Do you believe that this reduction in steps has brought any limitations compared to previous generations? Dr. Takagaki: Traditionally, one-bottle adhesives are too hydrophilic. This hydrophilicity also brings high water sorption, therefore the durability of the interface is compromised. At TMDU, we did not accept one-step bonding agents in clinical use based on results we obtained in our research in that area.

1 0

Water sorption/solubility of different bonding agents. Data provided by Tokyo Medical and Dental University.

Dr. Espigares: What do you think of the new MDP-Amide chemistry (included in CLEARFIL Universal Bond Quick) for overcoming such limitations? Dr. Takagaki: The MDP monomer has proved through research to be the best monomer for adhesion to tooth substrate. Nowadays, many manufacturers include MDP. Although the MDP purity and performance differs from Kuraray Noritake’s original one, in one-step bonding agents only MDP is not enough. The differential factor is the amide monomer that provides the desired high penetration and low water sorption.

COSMETIC & RESTORATIVE

Dr. Espigares: You and your work at TMDU, are very well known in the field of adhesive dentistry. Did your research show results that would support the abovementioned statements? Dr. Takagaki: In our research results, we observed indeed a lower water sorption compared to previous one-step generations. Actually, we were surprised to see water sorption levels equivalent to the two-step bonding agent gold standard: CLEARFIL SE BOND. The amide monomer behaves as hydrophilic before the polymerization and as hydrophobic after, which is the desired situation for one bottle, self-etching systems.

Dr. Espigares: Would you therefore recommend the usage of universal bonding agents in daily practice? Dr. Takagaki: Yes, but as mentioned, the MDP-amide chemistry is essential. It is noteworthy that another company is also using an amide monomer. However, our results at TMDU indicate that the performance in terms of penetration is not that good. Actually, we still saw lesion formation with that other company’s amide. Kuraray Noritake’s MDP-Amide chemistry is the only one that avoids lesion formation.

SEM (Scanning Electron Microscope) images of dentin-adhesive interface after acid-base challenge. OL: outer lesion; A/B: adhesive/bonding; D: dentin; R: resin; ABRZ; acid-base resistant zone. Although ADRZ was detected in the competitive universal adhesive (C), lesion formed at the bottom of the OL. No lesion formation was detected with CLEARFIL Universal Bond Quick. Images courtesy of Tokyo Medical and Dental University.

Dr. Espigares: Let’s get out of the laboratory. According to your clinical experience, is there any extra advice that you could provide for reliable adhesion? Dr. Takagaki: One important point that sometimes is missed is to properly air-dry the solvent for at least 5 seconds after the bond application. I also recommend selective enamel etch for achieving aesthetic margins, even if all universal bonding agents allow self-etching. Finally, I would like to talk about simplicity. We dentists tend to shorten the necessary time and sometimes the rubbing time is not respected. With Universal Bond Quick, our research showed no significant difference in bond strength with rubbing time is not respected. With Universal Bond Quick, our research showed not significant difference in bond strength and the rubbing time. Therefore, it reduces the risk of error, allowing consistent results. I believe that simplicity is required so the fact that Universal Bond Quick and PANAVIA SA Cement Universal can cover direct and indirect restorations is ideal for daily practice. Universal Bond Quick achieves what I am looking for in my practice: easy, quick, and reliable.

CLEARFIL Universal Bond Quick

CLEARFILSE BOND

Asterisks show no signifcant differences (p>0.05)

Bond strength upon rubbing time. Data provided by Tokyo Medical and Dental University.

Although the universal adhesive market is large, key properties like the above-mentioned may help in the complicated process of selecting a one-step adhesive that offers the best performance, simplicity, consistency and predictable results. DR TOMOHIRO TAKAGAKI DDS PhD

h en r y sc h e i n .c o m .a u

1 1

COSMETIC & RESTORATIVE

FINISHING & POLISHING OPTIONS AND USAGE

Komet Diamond Strips Designed for interproximal use and, depending on the grit, to either break the contact between two teeth or to finish the surface in the interdental area.

There is also an assortment available that contains 5 of each grit sizes in one tube (WS25A for 2,5mm width and WS37A for 3,7mm width).

Due to the single-sided grit, there is no risk in damaging the neighbouring tooth.

Compared to plastic strips, the service life is much longer as all diamond strips can be used multiple times without losing its shape.

The grit size itself is mentioned by its colour on each diamond strip according to the ISO-norms and is available in blue (medium), red(fine) and yellow (extra-fine).

Henry Schein Finishing & Polishing Discs

Maxima Composite Polishers

These discs provide effective contouring and polishing of your composite restoration. Made from a flexible thin polyester film with aluminium oxide abrasive the discs have a metal ring that sits securely on the pop on style mandrel.

Used mostly in high end aesthetic restorations, these are either silicon carbide coated or diamond coated. The diamond coated will have the ultimate hi shine and are longer lasting, they also tend to be more expensive.

Available in 2 popular diameters,

Options vary from single use, one step systems to reusable 3 step systems. The Maxima polishers are a two-step system offering excellent results as it combines non-diamond (prepolisher) and diamond (polisher). This combination makes them a better value option.

•

9.5mm (for use around the papilla and posterior) and

•

12.7 mm (more suited to larger surface contouring, incisal, vestibular surfaces).

Henry Schein Finishing and Polishing Discs are available in 4 grits, colour coded for easy identification. Dark green for coarse through to off white for extra fine.

1 2

COSMETIC & RESTORATIVE

TOOTH WHITENING POPULARITY TRANSFORMING SMILES WITH WHITE DENTAL BEAUTY

A world of social media, selfies, and more recently video conferencing, is making people more aware than ever of how their teeth - and their smiles - look. “Not many people know that tooth whitening is safe, easy and inexpensive. When I demonstrate these advantages to patients, they often recommend the treatment to others. This is one of the reasons why bleaching is becoming more popular and the demand is growing.” DR. ANNA SALAT, STYLE ITALIANO

Treatment options

Partner with White Dental Beauty

Toothpaste, Air polishing, Micro abrasion, Peroxides.

Quicker results, happier patients. With WDB’s unique Novon chemistry your patients can achieve results faster with either shorter wear times or lower peroxide concentration. Wear times for WDB are 6% HP 30 to 90 mins, 10% CP 2 to 4 hours, and 5% CP Mild 2 to 4 hours.

Peroxide whitening involves bleaching the teeth, and can be broken down into three distinct categories: Strips, pens, pre-made trays. This delivery of Hydrogen Peroxide is a professional alternative to less predictable over the counter products.

Reduces Sensitivity. High water content and active sensitivity management formula. For patients who suffer from sensitivity but still want to whiten their teeth there is the unique 5% CP Mild.

Professional home whitening. Custom tray whitening - the gold standard. Carbamide Peroxide or Hydrogen Peroxide gel in a custom fabricated tray is the traditional tried and tested way to lighten the internal pigments of teeth. This approach improves the appearance of teeth without altering any tooth structure.

Marketing support exudes luxury. Beautifully packaged (eco friendly) the take home whitening syringes come with a matching bag and patient literature, which help create the high end experience. Point of sale, patient video and posters are available to reinforce the brand image that will resonate with today’s savvy patients.

Professional ‘power’ bleaching in-office. All soft tissues are isolated, and chemically activated gel is applied to the tooth’s surface. In some cases a light is then put into position and directed at the gel to ‘enhance’ whitening.

Conveniently Affordable. White Dental Beauty is available in take home patient kits with 1.2ml x 8 syringes or a cost effective 3ml x 4 syringes.

Prospective patients need reassurance

Ask your Henry Schein representative today.

While treatment options are more readily available, the dental industry still must work to educate people on the benefits of professional treatment rather than over the counter whitening. Patients want to whiten their teeth and improve their smiles, but many are put off by the thought of visiting a dentist. They are concerned with comfort, cost, and convenience.

1 3 0 0

Watch video Nik Sethi from Square Mile Dental Practice explains how he transforms smiles using White Dental Beauty tooth Whitening gels.

6 5

8 8

2 2

1 3

COSMETIC & RESTORATIVE

AFFINIS THE CORRECT CHOICE OF IMPRESSION MATERIAL FOR IMPLANT PROSTHETICS

The market offers a large selection of elastomer impression materials for fixed prosthodontics. Requirements such as dimensional stability, resilience or bio-compatibility are just as important for implant as well as conventional fixed prosthodontics. The only difference for implant prosthetics is that additional emphasis is placed on high end-hardness.

In relation to the end-hardness, polyether materials have become well established as the classic material used in daily practice. However, independent scientific results reveal another point of view: The table below which compares the Shore A end-hardness between several different elastomeric impression materials after 15 minutes, 1 hour and 24 hours, demonstrates virtually the same values between addition-reaction silicone materials and polyether materials (Fig. 1). On the contrary, after 15 minutes, addition-reaction silicones show even slightly better values. The lower viscosity materials such as Impregum penta soft and addition-reaction light body silicones exhibit lower end- hardness values, which apply to both material groups.

Abb.1: Shore A end-hardness.

1 4

Impressions with different vis cosities Depending upon the viscosity, impres sion materials show different flow properties in the mouth of the patient. If one takes an impression on the same patient using different viscosities, a monophase material will indeed show stability, but will not flow around the structures to be modelled as well as a light or regular body material (Fig. 2,3). The new surface-activated AFFINIS PRECIOUS delivers excellent flow properties on the tooth surface. Yet, it does not drip or slump, due to the thixotropic pro perties of the material (Fig 4). Cross-sections of the impressions with ITI impression posts demonstrate how well the impression material flows around the posts (Fig. 5-7). Depending upon how necessary or useful it is, the dentist will ultimately decide on which viscosity of tray and syringe material to use for the implant impression. However, a lower viscosity syringe material will ensure that the oral structures are precisely reproduced. On the other hand, a monophase material gu arantees higher final strength overall. The importance of using impression materials with different viscosities becomes more essential, not only for implant posts, but also simultaneously for impressions on patients with subgingival marginal preparations. In these types of combined clinical cases, a low viscosity syringe material and a heavy body tray material is recommended.

COSMETIC & RESTORATIVE

Abb. 2: Monophase material

Abb. 3: Light body material

My material of choice is AFFINIS PRECIOUS light or regular body for this type of application because of its excellent legibility when combined with AFFINIS heavy body (Fig. 10). Generally, I prefer using the open impression technique for implant impressions. On one hand, the large retentive surface guarantees stable seating of the impression post in the impression. In contrast to this, there is a risk that the registration cap can be shifted in the impression. The screw fastening of the laboratory analogue provides the dental technician with more security during model fabrication. When performing the open impression technique, I proceed as follows: The entry point for the screw of the impression post is drawn onto the

Abb. 4: AFFINIS PRECIOUS regular body

individual tray and subsequently cut out using a diamond wheel (Fig. 8).The hole created is closed with a plastic wax strip to eliminate escape of the impression material when the impression is taken later. The tray can be easily respositioned onto the corresponding dimensional hole without difficulty during the impression procedure. The screw of the impression post presses through the wax strip cover to ensure that it can be easily located once the impression material has set. The wax and a plug of impression material that may be present is now removed from the screw opening using a hand instrument. The screw is then unscrewed and the entire impression removed (Fig. 9).

Abb. 5: Monophase material

Abb. 6: Combination of regular and heavy body material

Abb. 7: Combination of light and heavy body

Abb. 8

Abb. 9

Abb 10

PROF. DR. HERBERT DUMFAHRT University of Innsbruck Anichstrasse

h en r y sc h e i n .c o m .a u

1 5

COSMETIC & RESTORATIVE

COMPOSITE WHAT CAN IT DO ?

Because of the demands routinely placed on it, the classic material composite often has to withstand more than some materials used in space research. International opinion leaders have been asked what it is that modern high-performance composites can now achieve and what concrete tips experts have for easier handling of the material in the dental practice.

The usual requirements profile for the all-rounder composite is an ambitious list: a reliable restoration material should be mechanically stable, as long-lived as possible, biocompatible and highly aesthetic. It should also be easy to manipulate while enabling the dentist to work cost effectively. The current trend in material research is for in-house development of high-performance composites that mimic the natural properties of the teeth such as the low modulus of elasticity or extra long-lasting gloss. This biomimetic approach ensures that the restoration blends in harmoniously with the hard tooth structures of the particular patient. For decades, the Swiss dental specialist COLTENE has regularly surveyed aesthetic experts and restoration professionals around the world about their experiences with universal composite.

Within the framework of meetings with international key opinion leaders, the pioneers of aesthetic filling therapy have developed new ideas for dental practices and continually add to their range of diverse composite solutions. Aesthetically challenging restorations are, for example, prepared with the wide range of shades available in the MIRIS 2 system. The dimensionally stable, nano-hybrid composite Synergy D6, on the other hand, can be easily modelled. The latest gem from the company’s research laboratories in Alt-stätten is a range of premium composites known as ‘BRILLIANT’ and for good reason. Renowned dentists from around the world can testify to the exceptional material properties of the system based on the experience they have gathered in their routine treatments.

Fig 2a - c: Thanks to the wide range of shades available, dark areas can be rapidly and effectively camouflaged with an opague composite

1 6

COSMETIC & RESTORATIVE

Fig 3: Flow variants remain in place thanks to their thixotropic properties and can be modelled until polymerisation at the practitioners’ leisure

Fig 4: The universal composite BRILLIANT EverGlow provides glossy results.

implemented in a single layer even without ceramic using BRILLIANT EverGlow. Filling margins can be easily veneered thanks to the opacity of the material and the affected tooth does not require additional preparation. The principle dentist of the Smile Design Clinic in Moscow, Dr Zhanna Lipkind, agrees with her British colleague: ‘The universally applicable composite is now an integral part of my routine work. Out-standing results can be achieved with just a single shade. It can also be polished to produce a high gloss that is maintained, a property intrinsic to the material.’ The restorative dentistry specialist closely follows current developments in the manufacture and research of new highperformance composites.

Simple shade management and ideal shade integration As a renowned specialist for cosmetic dentistry, Dr Monik Vasant from London requires a restoration material that above all satisfies the most stringent aesthetic requirements. What is critical here is both good gloss retention and abrasion resistance but also the necessary translucence to create a natural look. He has used BRILLIANT EverGlow since its market launch in 2015: ‘Thanks to the predictable results, I use the material in all sorts of situations, every time I want to work using traditional VITA shades.’ In the Duo shade system, each composite mass covers two classic VITA shades from A1/B1 to A4/C4. Each of the seven universal (body) shades integrates almost seamlessly into its surroundings. For the highest aesthetic requirements, one of two enamel shades can be used to create translucent incisal edges or a youthful appearance for anterior teeth. To mask highly discoloured teeth and any shade deviations, it is recommended to use one of three opaque shades.

Application and layering strategy The American Dr Ross Nash, founder of the institute of dental learning of the same name in Huntersville, also values the rapid polishability of the composite using diamond burrs or silicone polishers suitable for composite. The time savings that result from using naturally brilliant materials cannot be underestimated, particularly with the heavily booked sched-ules of some joint practices.

According to Vasant, minimally invasive restorations that are visually appealing can be reliably

DR MONIK VASANT

DR ZHANNA LIPKIND

1 3 0 0

6 5

8 8

DR ROSS NASH

2 2

1 7

COSMETIC & RESTORATIVE

WHAT CAN COMPOSITE DO? Continued from pages 32-33

Fig. 5: BRILLIANT EverGlow family

In the same vein, his Portuguese colleague Dr João Carlos Tomas Ramos from the University of Coimbra praises the intuitive handling of the biomimetic mate-rial: ‘Both the shade selection and the actual restoration using natural layering are simple and effective.’ Dr Vasant states that a filler material suitable for routine use can be comfortably modelled until it polymerises without slumping. Good wettability also ensures that dimensionally stable composite adheres to bonded tooth surfaces and not to the instrument. Jörg Schwela, a private dentist in Switzerland, recommends using a low-viscosity option as a liner on the base of the cavity or when filling difficult to access areas. Thanks to the application needle that

DR JOAO CARLOS TOMAS RAMOS

1 8

is supplied, the composite is applied directly onto the bonded surface from the syringe in a con-trolled manner. High-performance composites have long maintained an important position in routine use in Germany as well, said practice owner Dr Sylvia Rahm. ‘For me, the future of restorative dentistry lies in minimally invasive adhesive technology,’ said the leader of many workshops and continuing education sessions on the topic of innovative anterior restoration. ‘BRILLIANT EverGlow is the filling and luting material for everyday use. The smooth consistency enables confident model-ling by hand.’ Even in the CAD/CAM area, compositebased solutions are being used more and more often thanks to their den-tine-like modulus of elasticity and their exceptional grinding precision.

MED DENT JORG SCHWELA

COSMETIC & RESTORATIVE

Fig. 6: Demonstration model with CAD/CAM generated dental restoration based on composite

Luting is carried out with a custom bonding system, the universal composite of the same name or, depending on the clinical situation, a dual-curing cement from the same manufacturer. The name of the BRILLIANT product family is also clearly a part of the program according to Dr Rahm: ‘The material is im-pressive primarily because of its long-last-ing gloss even with minimal polishing. The design of the fissures remains wonder-fully preserved in the process.’ Clarence Tam, managing director and owner of the New Zealand Academy of Cosmetic Dentistry (NZACD), describes in similar terms the outstanding chameleon effect that she has observed in her previous cases: ‘The satin-like appearance always looks really good in the followup examination, provided you can tell by just looking exactly where the prepared restoration is hidden.’

Summary Modern high-performance composites offer the dentist a range of possible ap-plications. While ‘selfflowing’ low-viscosity variants can make treating difficult to access sites considerably easier, CAD/ CAM blocks based on composite enable costeffective and efficient preparation of permanent restorations using digital technology. Unlike more brittle materials such as ceramic, composite has the additional advantage that any corrections that are needed can be quickly and easily pro-cessed and repaired at any time. International specialists recommend applying a submicron universal composite such as BRILLIANT EverGlow directly from the ap-plication tip onto the bonded surface and then polishing the restoration to a brilliant shine in just a few steps.

DR SILVIA RAHM

h en r y sc h e i n .c o m .a u

CLARENCE TAM

1 9

ENDODONTIC SOLUTIONS

CLINICAL MANAGEMENT OF HIDDEN APICAL CURVATURES

In the great majority of cases apical curvatures are distally oriented and easily visible in traditional 2D periapical radiographs. However, in some cases endodontists may suspect (i.e. files do not progress easily) or sometimes detect (by CBCT or using Clark’s buccal object rule) hidden abrupt curvatures with different orientations. In such cases the advice is to use very flexible, fatigue resistant, martensitic files (in the present case we used EdgeEndo X7 size 17 and 25 taper .04), with a reduced bounce-back effect to minimise the risks of ledges or apical transportation. In these narrow apical curvatures X7 rotary instruments can be used with a clockwise reciprocating motion (150°- 30°) to increase resistance to torsional stress. Otherwise, when using continuous rotation, the recommendation is to slightly reduce the safety torque limits. By doing so, we improve both torsional and flexural resistance, and safely manage these dangerous hidden abrupt curvatures.

CASE REPORT A 65 years old patient was referred for endodontic treatment of her second lower molar (#37). She reported a history of spontaneous pain, swelling and dental fistula. Proceeding pulp vitality tests and radiographic examination, the tooth was diagnosed with symptomatic apical periodontitis. Looking at this pre-operatory radiograph, two bits of information regarding this endodontic case should be detected (Fig.1): • Obliterated pulp chamber and narrow canals

• The non-conventional anatomy of distal root

‣ Fig 1

A traditional cavity access was performed using high speed diamond burs and the three orifices were located with ultrasonic tips. K-file #08 was used to scout the endodontic system of all roots, although it could not reach the apex in the distal canal. Pre-flaring and middle third instrumentation were gained with EdgeOne Fire (EdgeEndo, Albuquerque, NM) reciprocating small (yellow) file.

2 0

Pecking strokes of 1-2mm were used, alternating with some brushing action to coronally flare canals. Frequent and copious manual irrigation was performed using solutions 5% sodium hypochlorite. Following shaping of coronal and middle part, WL was determined with K-File #10 and shaping procedure were completed with martensitic X7 (EdgeEndo, Albuquerque, NM) instruments in sizes 17 and 25 .04 taper. The instruments were used with a clockwise reciprocating motion (150-30) to increase resistance to both torsional and flexural stress (Fig.2). Fig 2

Final irrigation was performed activating first an EDTA solution for 1 minute using sonic activation, followed by 1 min sonic activation of NaOCl. The root canal system was rinsed, dried and then obturated with a hydraulic single cone-technique and bioceramic sealer. Two periapical radiographs with different angulations were taken to verify treatment quality (Fig.3-4). The clinician’s suspicion of unusual anatomy of the distal root was confirmed by the angulated radiograph that showed an abrupt hidden curvature in the apical third of the canal. Nevertheless the crown-down approach (shaping the coronal and middle part first, thus reducing coronal interferences) and the proper selection of very flexible and resistance instruments, combined with a safer reciprocating clinical motions, allowed for proper negotiation of the hidden curvature with no iatrogenic errors.

Fig 3

The X7 instruments were chosen because of their innovative manufacturing process, which provides them with unprecedented flexibility and resistance to cyclic fatigue. Allowing practitioners to perform procedures that would be Fig 4 difficult, if not unimaginable, with traditional non-heated files. More precisely, EdgeEndo has focused research and development in the heat-treatment of NiTi files and has developed a proprietary process to produce FireWire™ files that exhibit 2 to 8 times* the resistance to cyclic fatigue (and flexibility) than other NiTi files. The benefits of a flexible file seem obvious in complex curvature, but martensitic X7 files also offer another advantage: less “shape memory”. Although shape memory may seem beneficial, it can cause a file to “bounce back” in the tooth, putting lateral pressure on the canal wall, potentially leading to canal transportation or ledging. The present case shows the excellent clinical performance of the X7 files in very complex anatomy, by avoiding the above mentioned, common iatrogenic errors. Reference: Dosanijh. A, et al. The Effect of Temperature on Cyclic Fatigue of NiTi Rotary Endodontic Instruments 2017 J Endod 2017; 43: 823-826.

PROFESSOR GIANLUCA GAMBARINI, University of Rome, La Sapienza School, Rome Italy

1 3 0 0

DR. ALESSIO ZANZA University of Rome, La Sapienza School, Rome Italy

6 5

8 8

2 2

2 1

ENDODONTIC SOLUTIONS

WHY OTR ? OPTIMUM TORQUE REVERSE

When instrumenting, endodontic files are always exposed to mechanical forces such as friction resistance and/or clamping force in the root canal, which act on the file as torque during rotary preparation. This resistance counteracts the drive torque of the endomotor and can cause the file to twist (torsion). Under certain conditions (torsion strength and frequency of repetition) this may cause the file to break.

File Stress

1. Cyclic 1. Fatique Cyclic Fatigue

2 2

File Stress

2. Torsional Fatique 2. Torsional Fatigue

3.3.Cyclic andTorsional Torsional Fatique Cyclic and Fatigue

ENDODONTIC SOLUTIONS

Therefore, the torque acting on the file must be limited. Such a limitation can be realized in different ways: 1. Controlling the pressure acting on the file manually, i.e. working „with feeling“. This is relatively feasible when the preparation is done by hand. However, when a preparation motor is used, the tactile sensation is basically lost. Cyclically rotate the file backwards (opposite to the cutting direction) in order to relieve the stress. The most pragmatic application of this method is relieving the file periodically after certain time intervals or rotational angles. This occurs, for example, in reciprocating modes of operation. Periodic motions may not be very original, but they are easy to realise as far as engineering is concerned. One disadvantage is that the individual situation of a root canal isn’t taken into consideration. 2. The torque acting on the file (impeding) can be measured. Hence, it is possible to automatically relieve the file only when this is really necessary and expedient. In other words, the actual stress acting on the file controls the cycle (torqueprovoked reversal of rotation direction). This function is called Auto Torque Reverse and was realized for the first time in the world in Morita’s TriAuto ZX, later also in the endodontic motors DentaPort ZX and TriAuto mini as well as the treatment unit Soaric. Since this method has proven its worth, endodontic motors made by other manufacturers are increasingly being fitted with Auto Torque Reverse functions.

Also, such quantitative criteria as length of the measuring intervals or reverse rotation of the file affect not only the time needed for the therapy but also the effectiveness and consequently, the safety of the reversal of the direction of rotation. 4. It is in this respect that Morita once again is setting a new standard with Optimum Torque Reverse. Although the OTR function also uses torque-provoked reversal of the direction of rotation, OTR requires only a very small angular rotation of the file to provide safe feedback about its current stress. Accordingly, you can work with optimized rotation angles both when the file is rotating in the direction of cutting and the reverse direction. Material tests have shown that nickel-titanium files can tolerate torsion of half a rotation (180°) in the direction of cutting. In the reverse direction of rotation, a quarter rotation (90°) is needed to release the file. Extensive experiments and tests in dental practices with different file systems and brands have confirmed these values. Tri Auto ZX2 and DentaPort with OTR continues to be a universal system for almost all file systems.

3. Nonetheless, there are qualitative differences between the different Auto Torque Reverse functions, which become evident in connection with such criteria as, for example, measuring accuracy and speed of the control circuit.

h en r y sc h e i n .c o m .a u

2 3

ENDODONTIC SOLUTIONS

REMOVER THE ULTIMATE SOLUTION FOR REMOVING GUTTA PERCHA

Endodontic retreatment is generally considered the first choice option when failure of an initial treatment occurs. The presence of bacteria and their by-products embedded in the failing obturation material and in canal intricacies is often linked to the loss of integrity of the hermetic seal of the initial filling, leading to the spread of post-treatment disease. It is therefore of utmost importance to remove all the root canal filling material effectively prior to negotiating the canals to their full extent. Several techniques and instruments have been proposed to remove gutta-percha, including hand files or mechanical instru-ments or a combination of both. Nowadays, manual files are generally regarded as time-consuming and the current trend is towards more efficient tools, such as rotary instruments. Since the beginning of the 2000s, specific endodontic files have been designed to improve the removal of gutta-percha. R-ENDO (COLTENE Micro-Mega) was the first sequence available, followed rapidly by ProTaper Universal Retreatment (Dentsply Sirona). These two sequences have three files and are used with the crown down technique. Later, many systems were developed by several companies, such as D-Race from FKG Dentaire, Mtwo R from VDW and Endo ReStart from Komet, and these presented different profiles, cross sections and recommended techniques. Moreover, several developments have marked the last two dec-ades and changed the way we practise endodontics, among them the single-file concept and the heat treatment process. The response to the increasing demand by dental clinicians for a simplified process led to new shaping systems with a single file. The aim was to replace multiple-file systems in the initial canal treatment, but it was later recommended for retreatment too. The advent of new manufacturing processes, such as surface finishing or heat treatment, aiming to upgrade the mechanical performance of nickel– titanium (NiTi) files led to new file systems that are more flexible and more resistant to cyclic fatigue.

2 4

The Remover (COLTENE) has benefited from all these technological advances and concepts for removal of obturation material. Removal of different sealers A retreatment file is supposed to go through the deficient obturation material and remove it from the canal. This material generally includes a core material (gutta-percha) sealed to the canal walls with a fine film of endodontic sealer. Different types of sealers have been used over the years. Historically, zinc oxide eugenol sealers were the first, but many others have been proposed to improve different proper-ties of the sealer. These include resin-based sealers to improve the hermetic seal and adhesion to the canal walls; silicone-based sealers, which are well tolerated by tissue and have low water resorption; epoxy resin-based sealers for the possibility of adhesion to dentine and lower rates of water solubility; sealers based on mineral trioxide aggregate which have a predilection towards mineralization; calcium silicate sealers, commonly referred to as “bioceramics” owing their excellent biological properties; and calcium phosphate and calci-um-enriched mixture sealers with the potential to promote bone regeneration and induce cementogenesis. The purpose of such an instrument would therefore be to remove the initial obturation material, paving the way for access to the non-instrumented area with conventional NiTi instruments and thus proper reshaping of the canal space. The Remover has benefitted from state-of-the-art technology in material processing and long experience in file

ments or a combination of both. Nowadays, manual files aim was to replace multiple-file systems in the initial canal treatment, are generally regarded as time-consuming and the current trend is but it was later recommended for retreatment too. are generally regarded as time-consuming and the current trend is but it was later recommended for retreatment too. towards more efficient tools, such as rotary instruments. Since the The advent of new manufacturing processes, such as surface towards more efficient tools, such as rotary instruments. Since the The advent of new manufacturing processes, such as surface beginning of the 2000s, specific endodontic files have been designed finishing or heat treatment, aiming to upgrade the mechanical beginning of the 2000s, specific endodontic files have been designed finishing or heat treatment, aiming to upgrade the mechanical to improve the removal of gutta-percha. R-ENDO (COLTENE Microperformance of nickel–titanium (NiTi) files led to new file systems to improve the removal of gutta-percha. R-ENDO (COLTENE Microperformance of nickel–titanium (NiTi) files led to new file systems Mega) was the first sequence available, followed rapidly by ProTaper that are more flexible and more resistant to cyclic fatigue. Mega) was the first sequence available, followed rapidly by ProTaper that are more flexible and more resistant to cyclic fatigue.

ENDODONTIC SOLUTIONS

EDM PaperPoints and HyFlex™ EDMHyflex Paper and Gutta-Percha HyFlex™ EDM Paper and Gutta-Percha Points Gutta-Percha Points

HyflexPoints CMGreater GuttaPercha Points HyFlex™ CM GuttaPercha Taper HyFlex™ CM GuttaPercha Points Greater Taper Greater Taper

NOVEMBER 2020 | ENDODONTICS NOVEMBER 2020 | ENDODONTICS HyFlex EDM Paper and Guttapercha points selection HyFlex EDM Paper and Guttapercha points selection

HyFlex CM Guttapercha points Greater Taper selection HyFlex CM Guttapercha points Greater Taper selection

Size / tape

Paper points Guttapercha points .04 #20 60 pcs 60022689 The Remover (COLTENE) has benefited from all these technological This (Fig. 1) boasts numerous specifications and Size / tape Paper points Guttapercha points .04 #20unique instrument 60 pcs 60022689 The Remover (COLTENE) This unique instrument (Fig. 1) boasts numerous specifications and 100has pcs benefited from all 60these pcs technological .06 #30 60 pcs 60022699 advances and concepts material. technical characteristics, including: 100for pcsremoval of obturation 60 pcs advances and concepts for removal of obturation material. technical characteristics, including: .06 #30 60 pcs 60022699

20 /. 05

60022742 60022706 .06 #45 60 pcs 60022702 20 /. 05 60022706 .06 60 60022702 different60022742 sealers #45 a non-cutting tipmm, of pcs 30/100 mm, allowing safe use in curved Removal ofRemoval differentof sealers  #60 a non-cutting tip of allowing safe use in curved OneFile 25/~ 60022743 60022707 .04 6030/100 pcs 60022696 OneFile 60022743to go through the #60 60022696 A retreatment file istosupposed deficient obturation canals (Fig. 2); 60 pcs A retreatment file 25/~ is supposed go through the deficient60022707 obturation canals .04 (Fig. 2); 40 /. 04 60022676 60022708 .04 #20-45 60 pcs 60022703 remove it60022676 from thematerial canal. This material generally includes .04 #20-45 40material /. 04 and 60022708 60 pcs 60022703 material and remove it from the canal. This generally includes a core material (gutta-percha) sealed towalls the canal triple-helix a variable cross section, symmetrical 50 /. 03 material 60022741 60022709 60022704 .06 100triple-helix pcs section, a core to the canal with awalls fine with a#20-45 afine variable cross symmetrical in the first 3in the first 3 50 /. 03(gutta-percha) sealed 60022741 60022709 60022704 .06 #20-45 100 pcs film of endodontic sealer. Different typeshave of sealers have been used mm then asymmetrical 60 /. 02 60022740 60022710 film of endodontic sealer. Different types of sealers been used mm then asymmetrical towards thetowards shaft; the shaft; 60over /. 02the years. Historically, 60022740 60022710 were the first, zinc oxide eugenol over the years. Historically, zinc oxide eugenol sealers weresealers the first, Assortment but many others have beentoproposed to improve different proper alimited 7 % taper limited to mm the first mm and followed Assortment but many others have been proposed improve different proper a 7 % taper to the first 10 and10 followed bya 0 % bya 0 % 20/.05 - 60/.02 60022744 60022705 ties of the sealer. These include resin-based sealers to the towards taper shaft in order toperiradicular preserve periradicular - 60/.02 60022744 60022705 ties of the20/.05 sealer. These include resin-based sealers to improve theimprovetaper thetowards shaft inthe order to preserve

hermetic seal and the canal walls; silicone-based sealers, hermetic seal and adhesion toadhesion the canalto walls; silicone-based sealers, dentine; dentine; which are wellbytolerated by have tissuelow andwater have resorption; low water resorption; which are well tolerated tissue and epoxy resin-based sealers for theof possibility to dentine  a proprietary thermomechanical process called C-wire, sealers for the possibility adhesionoftoadhesion dentine  a proprietary process called C-wire, designepoxy andresin-based has been developed by COLTENE in athermomechanical proprietary thermomechanical process called and lower rates of watersealers solubility; sealers based trioxide on mineral trioxide entailing electropolishing and heatand treatment and increasing and lower rates of water solubility; based on mineral entailing electropolishing and heat treatment increasing response to the dental community’s increasing C-wire, entailing electropolishing and heat aggregate have a predilection towards mineralization; flexibility and cyclic fatigue resistance. aggregate which have which a predilection towards mineralization; calcium calcium flexibility and cyclic fatigue resistance. silicate sealers, commonly referred to as “bioceramics” owing their demand for a means of safe, simple and swift treatment and increasing flexibility and cyclic silicate sealers, commonly referred to as “bioceramics” owing their excellent properties; biological properties; and calcium phosphate calciPreparation technique for use excellent biological and calcium phosphate and calci- and Preparation – technique use removal of gutta-percha in retreatment procedures. fatigue– for resistance. um-enriched mixture with thetopotential promote bone Once cavity the access cavityreopened has beencanal reopened canalloentrances loum-enriched mixture sealers withsealers the potential promotetobone Once the access has been entrances regeneration induce cementogenesis. cated and gutta-percha confirmed to befilling the canal filling material, regeneration and induceand cementogenesis. cated and gutta-percha confirmed to be the canal material, This unique instrument (Fig. 1) boasts numerous The purpose of such an instrument would be to remove an orifice modifier EDM,or COLTENE; or COLTENE One Flare, COLTENE – (HyFlex technique for Flare, use The purpose of such an instrument would therefore betherefore to remove an orificePreparation modifier (HyFlex EDM, COLTENE; One specifications and technical characteristics, the initial obturation material, way to forthe accessMicroMega) to the MicroMega) can be introduced into the gutta-percha the initial obturation material, paving thepaving way forthe access can be introduced into the gutta-percha for 2–3 mmfor on2–3 mm on non-instrumented area with conventional NiTi instruments thus Once continuous at 400–800 acavity speed of 400–800 rpm. This instrument is including: the has been reopened canal non-instrumented area with conventional NiTi instruments and thus and continuous rotation at rotation aaccess speed of rpm. This instrument is proper of reshaping the canal Thehas Remover has benefitted used to create a pilot hole, guide the engagement of the located and proper reshaping the canalofspace. The space. Remover benefitted used to entrances create a pilot hole, guide thegutta-percha engagement ofconfirmed the afrom non-cutting tiptechnology of 30/100 mm,inprocessing allowing safe from state-of-the-art technology material processing long inside Remover inside the gutta-percha achieve aaccess. straighter access. state-of-the-art in material and long and Remover the and achieveand a straighter beRemover thegutta-percha canal filling an orifice modifier experience in file design anddeveloped has been developed in toThe should be usedmaterial, in continuous rotation at 400–800 rpm use in curved canals 2); experience in file design and(Fig. has been by COLTENEbyinCOLTENE The Remover should be used in continuous rotation at 400–800 rpm (HyFlex EDM, COLTENE; orThe One Flare, tocommunity’s the dental community’s increasing means Ncm with very light apical guidance. 19 COLTENE mm Removresponse toresponse the dental increasing demand fordemand a meansfor aand 3.0–3.5and Ncm3.0–3.5 with very light apical guidance. 19 mm The Removoftriple-helix safe, and swift of gutta-percha in retreatment er is introduced into opening created byinto the and moved aofvariable cross section, symmetrical MicroMega) canthe be introduced the gutta-percha safe, simple andsimple swift removal of removal gutta-percha in retreatment er is introduced into the opening created by the opener andopener moved procedures. in an apical direction overofa 2–3 distance of 2–3 mmresistance until slight resistance direction over a distance mm until slight inprocedures. the first 3 mm then asymmetrical towards the in an apical for 2–3 mm on continuous rotation at a speed of to inward movement is felt,it and then shouldout be while pulled out while to inward movement is felt, and then should beitpulled

•

• •

shaft;

•

400–800 rpm. This instrument is used to create a pilot hole, guide the engagement of the Remover inside the gutta-percha and achieve a straighter access.

a 7 % taper limited to the first 10 mm and followed bya 0 % taper towards the shaft in order to preserve periradicular dentine; HyFlex™ CMPaper and EDM Paper Points HyFlex™ CM and EDM Points

HyFlex CM Paper Points, drawer box HyFlex CM Paper Points, drawer box Files Size 15/.04 20/.04 25/.04 30/.04 35/.04

40/.04 45/.04 50/.04

Files Size 15/.04 20/.04 25/.04 30/.04 35/.04

40/.04 45/.04 50/.04

60/.04

25/.06

Hyflex CM and EDM Paper Points

HyFlex CM Paper Points, 100 pcs HyFlex CM Paper Points, 100 pcs 60022671 60022671 60022672 60022672 60022673 60022673 60022674 60022674 60022675 60022675

60022676 60022676 60022677 60022677 60022678 60022678 60022679 60022679

HyFlex EDM Paper Points, drawer box HyFlex EDM Paper Points, drawer box

/.04 60022680 AssortmentAssortment 20-45 /.04 20-45 60022680 20/.06 60022682 20/.06 60022682 30/.06 35/.06 40/.06

30/.06 35/.06 40/.06

HyFlex EDM Paper Points, 100 pcs HyFlex EDM Paper Points, 100 pcs 60022742 60022742 OneFile 25/~ 60022743 OneFile 25/~ 60022743 40/.04 60022676 40/.04 60022676 50/.03 60022741 50/.03 60022741 60/.02 60022740 60/.02 60022740 Assortment 20/.05 - 60/.02 60022744 Assortment 20/.05 - 60/.02 60022744 Files Size

60022683 60022683 60022684 60022684 60022685 60022685 60022686 60022686

45/.06 60022687 60022687 /.06 60022688 AssortmentAssortment 20-45 /.06 20-45 60022688 45/.06

1 3 0 0

6 5

Files Size 20/.05

20/.05

8 8

2 2

2 5

ENDODONTIC SOLUTIONS

REMOVER: THE ULTIMATE SOLUTION FOR REMOVING GUTTA PERCHA Continued from pages 18-19

The Remover should be used in continuous rotation at 400–800 rpm and 3.0–3.5 Ncm with very light apical guidance. The 19 mm Remover is introduced into the opening created by the opener and moved in an apical direction over a distance of 2–3 mm until slight resistance to inward movement is felt, and then it should be pulled out while on selective canal walls of dislodge all the gutta-percha. In general, all the filling material can be removed with a series of three to four in and out motions in a downwards apical direction (Figs. 3a–h). The removed material usually comes out in small shavings (Fig. 4), but also as a mass of guttapercha. The removal of the filling material must be followed by copious irrigation in order to wash away all the debris and sealer residue. Once all the filling material has been removed, scouting and glide path creation can be carried out using manual or NiTi files. Standard reshaping instruments such as 2Shape, One Curve (COLTENE MicroMega), or HyFlex CM or EDM (COLTENE) can now be used to clean and shape the non-filled canal space and to ensure the smooth transition between previously filled and unfilled portions. Clinicians must keep in mind that a continuously tapered preparation is essential for 3D obturation. When clinical and radiographic diagnoses indicate retreatment of a case showing obturation material reaching the apical area, the clinician is advised to limit the use of the Remover to 2 mm short of the estimated working length. The objective is to prevent potential overextension of filling material into the periapical area. The filling material in the last 2 mm can be carefully and se-curely removed with manual files. Once all previous material has been removed, the cleaning and shaping can be undertaken using standard NiTi shaping instruments (Figs. 5a & b).

PROF. WALID NEHME Space 2 Center New Jdeiden Street, Beirut, Lebanon walidnehmeendo@gmail.com

2 6

Flexible retreatment The Remover is available in two lengths: 19 and 23 mm. A large number of cases can be addressed with 19 mm files. If the 19 mm Remover does not reach the full extent of the filling material, the 23 mm file can be used to make up for the missing millimetres. This new instrument, specifically designed for endodontic re-treatments, embodies the current concepts in endodontics and uses the most recent advances in technology (asymmetry, electropolishing and heat treatment). The diameter of the wire of the Remover is only 1 mm, which makes it smaller than that of the majority of re-shaping or retreatment instruments. Moreover, it allows for mini-mally invasive removal of filling material while ensuring increased blade flexibility. It is a single-use instrument; however, removing the filling ma-terial from two teeth in the same patient is possible. In this case, the instrument should be carefully inspected after use and discarded when unwinding occurs. Conclusion This instrument allows the removal of guttapercha canal filling swiftly, thoroughly and safely, transforming this difficult procedure into a more predictable and easier task. Finishing the preparation size and taper varies according to the anatomy of each clinical case. Clinicians should keep in mind that the size and taper of the selected final shaping file should allow a total elimination of the filling material and the cleaning and shaping of the apical third. This step should obviously be accompanied by abundant irrigation and acti-vation of the irrigants using specifically designed ultrasonic gener-ators and tips such as EndoUltra (COLTENE MicroMega). Thorough cleaning and shaping complete the retreatment procedure, facilitate the 3D obturation and promote a successful root canal therapy outcome.

ENDODONTIC SOLUTIONS

NOVEMBER 2020 | ENDODONTICS

ENDODONTICS | NOVEMBER 2020

Figure 1

Figure 2

Figure 3a

Figure 3b

Figure 3c

Figure 3d

Figure 3e

Figure 3f

Figure 3g

Figure 3h

Figure 4

Figure 5a

Figure 5b

Figure 6a

Figure 6b

leaning on selective canal walls o dislodge all the gutta-percha. In general, all the filling material can be removed with a series of three to four in and out motions in a downwards apical direction (Figs. 3a–h). The removed material usually comes out in small shavings (Fig. 4), but also as a mass of gutta-percha. The removal of the filling material must be followed by copious irrigation in order to wash away all the debris and sealer residue. Once all the filling material has been removed, scouting and glide path creation can be carried out using manual or NiTi files. Standard reshaping instruments such as 2Shape, One Curve (COLTENE MicroMega), or HyFlex CM or EDM (COLTENE) can now be used to clean and shape the non-filled canal space and to ensure the smooth transition between previously filled and unfilled portions. Clinicians must keep in mind that a continuously tapered preparation is essential for 3D obturation. When clinical and radiographic diagnoses indicate retreatment of a case showing obturation material reaching the apical area, the clinician is advised to limit the use of the Remover to 2 mm short of the estimated working length. The objective is to prevent potential overextension of filling material into the periapical area. The filling material in the last 2 mm can be carefully and securely removed with manual files. Once all previous material has been removed, the cleaning and shaping can be undertaken using standard NiTi shaping instruments (Figs. 5a & b).

instrument should be carefully inspected after use and discarded when unwinding occurs.

Conclusion Fig. 1: Remover for the HyFlex and MicroMega file This instrument allows the removal of gutta-percha canal filling swiftly, thoroughly and safely, transforming this difficult procedure systems (© Coltène/Whaledent). into a more predictable and easier task. Finishing the preparation size and taper varies according to the anatomy of each clinical case. Clinicians should keep in mind that the size and taper of the selected final shaping file should allow a total elimination of the filling material and the cleaning and shaping of the apical third. This step should obviously be accompanied by abundant irrigation and activation of the irrigants using specifically designed ultrasonic generators and tips such as EndoUltra (COLTENE MicroMega). Thorough cleaning and shaping complete the retreatment procedure, facilitate the 3D obturation and promote a successful root canal therapy outcome.

Fig. 2: Scanning electron microscope image of the tip of the Remover (© Franck Diemer).

References 1.

Bergenholtz, G. “Assessment of Treatment Failure in Endodontic Therapy”. Journal of Oral Rehabilitation 43, no. 10 (October 2016): 753 58.

Fig. 4: Photograph of the shavings created by the Remover (© Jean-Philippe Mallet).

About the Author: Prof. Walid Nehme is a clinical professor in the department of endodontics of Saint Joseph University of Beirut in Lebanon, where he received his DDS in 1988 and MSc in 1994. His academic activities lie in undergraduate and postgraduate education in endodontics and focus on clinical training and practice and supervision of research projects. He runs postgraduate endodontic courses and hands-on courses in the Middle East, Africa, Europe and Canada. Prof. Nehme works in a referral-based practice limited to endodontics in Beirut and Abu Dhabi in the UAE. He is an analyst and opinion leader for clinical trials for endodontic manufacturers and has contributed to the development of new files and devices in endodontics. He has published scientific and clinical articles in peer-reviewed journals nationally and internationally on such subjects as root canal anatomy, instrumentation techniques, NiTi files, irrigation procedures, obturation and retreatment. He is a fellow of the International College of Dentists, an international member of the American Association of Endodontists, a council member of the Asian Pacific Endodontic Confederation, a founder member and a past president of the Arab Endodontic Society, and a past president of the Lebanese Society of Endodontology.

Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979; 5:83–90.

Alharmoodi R, Al-Salehi S. “Assessment of the Quality of Endodontic Retreatment and Changes in Periapical Status on a Postgraduate Endodontic Clinic”. Journal of Dentistry 92 (January 2020): 103261.

Covello F, Franco V, Schiavetti R, Clementini M, Mannocci A, Ottria L, Costacurta M. Prevalence of apical periodontitis and quality of endodontic treatment in an Italian adult population, Oral & Implantology 3(4) (2010): 9–14

Al-Omari M.A., Hazaa A., Haddad F. Frequency and distribution of root filled teeth and apical periodontitis in a Jordanian subpopulation, Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics 111(1) (2011): e59–65.

K.M. Barrieshi-Nusair, M.A. Al-Omari, A.S. Al-Hiyasat, Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan, Journal of Dentistry 32(4) (2004): 301–7.

Friedman S, Mor C. The success of endodontic therapy—healing and functionality. J Calif Dent Assoc. 2004;32:493–503.

Bender IB, Seltzer S, Soltanoff W. Endodontic success are appraisal of criteria. Oral Surg Oral Med Oral Pathol.1966; 22: 790–802.

SBU. Methods of diagnosis and treatment in endodontics. Stockholm: Stockholm: Swedish Council on Health Technology Assessment (SBU), 2010. SBU report no. 203. http://www.sbu.se/upload/Publikationer/, accessed 13 August 2010.

Figs. 5a & b: Teeth #21 and #22 requiring retreatment: pre-op radiograph (5a); post-op radiograph (5b) (© Walid Nehme).

Figs. 6a & b: Pre-op radiograph of a maxillary first molar present-ing with periapical periodontitis with a forgotten canal in the mesiovestibular root (6a). Post-op radiograph after filling removal with the Remover, cleaning and shaping with the 2Shape and apical finishing with the F40 (0.40 tip and 4 % Contact: taper) in palatal and disto-buccal canals (6b) (© Prof. Walid Nehme Space 2 Center Walid Nehme). New Jdeiden Street

10. Möller ÄJ, Fabricius L, Dahlén G, Sundqvist G, Happonen RP. Apical periodontitis development and bacterial response to endodontic treatment. Experimental root canal infections in monkeys with selected bacterial strains. Eur J Oral Sci. 2004; 112: 207–215.

11. Bicego-Pereira EC, Barbosa-Ribeiro M, de-Jesus-Soares A, Zaia AA, Ferraz CCR, Almeida JFA, Marciano MA, Feres M, Gomes BPFA. “Evaluation of the Presence of Microorganisms from Root Canal of Teeth Submitted to Retreatment Due to Prosthetic Reasons and without Evidence of Apical Periodontitis”. Clinical Oral Investigations, 20 Jan 2020. [epub ahead of print] 12. Shetty K, Habib VA, Shetty SV, Khed JN, Prabhu VD (2015) An assessment of coronal leakage of permanent filling materials in endodontically treated teeth: an in vitro study. J Pharm Bioallied Sci 7(Suppl 2): S607–S611.

Beirut, Lebanon walidnehmeendo@gmail.com More information at: https://remover.coltene.com

13. Yamaguchi M, Noiri Y, Itoh H, Komichi S, Yagi K, Uemura R, Naruse H, Matsui S, Kuriki N, Hayashi M, Ebisu S. “Factors That Cause Endodontic Failures in General Practices in Japan”. BMC Oral Health 18, no. 1 (December 2018): 70. 14. Fabricius L, Dahlén G, Sundqvist G, Happonen RP, Möller ÄJ. Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth. Eur J Oral Sci. 2006; 114: 278–285. 15. Hülsmann M, Peters OA, Dummer PMH Mechanical preparation of root canals: shaping goals, techniques and means. Endodontic Topics, 2005 (10), 30–76.

006603 02.21

Figs. 3a–h: Retreatment of a tooth #46 pre-op radiograph (3a); the Remover is positioned at  Fig. 1: Remover for the HyFlex MicroMega file systems the entrance to the mesiolingual canal (3b)andand (© Coltène/Whaledent). is progressively advancinginto the gutta-percha Fig. 2: Scanning electron microscope image of the tip of the (© Franck Diemer). (3c); pathway created by theRemover Remover after its first Flexible retreatment  Figs. 3a–h: Retreatment of a tooth #46 pre-op radiograph (3a); central advance into (3d); mesial The Remover is available in two lengths: 19 and 23 mm.the A large gutta-percha the Remover is positioned at the entrance to the mesiolingual number of cases can be addressed with 19 mm files. If the 19 mm canal (3b) and is progressively advancing into the gutta-percha shaping and me-chanical irrigation Removercanals does not reachafter the full extent of the filling material, (3c); pathway created by the Remover after its first central advance the 23 mm file can be used to make up for the missing millimetres. into the gutta-percha (3d); mesial canals after shaping and me(2Shape TS2designed andfor endodontic F35 finishing files,(2Shape COLTENE This new instrument, specifically rechanical irrigation TS2 and F35 finishing files, COLTENE treatments, embodies the current concepts in endodontics and uses MicroMega) (3e); pre-op radiograph to check the master cones the most recent advances in technology(3e); (asymmetry, electropolish- radiograph (3f ); post-op radiograph (3g); post-op radiograph offset MicroMega) pre-op tocentred check the ing and heat treatment). The diameter of the wire of the Remover is (3h) (© Jean-Philippe Mallet). only 1 mm, which makes itcones smaller than that of the majority of remaster (3f); post-op radiograph centred (3g); shaping or retreatment instruments. Moreover, it allows for mini Fig. 4: Photograph of the shavings created by the Remover mally invasive removal of filling material while ensuring offset increased (© Jean-Philippe Mallet). post-op radiograph (3h) (© Jean-Philippe blade flexibility. It is a single-use instrument; however, removing the filling ma Figs. 5a & b: Teeth #21 and #22 requiring retreatment: pre-op Mallet). terial from two teeth in the same patient is possible. In this case, the radiograph (5a); post-op radiograph (5b) (© Walid Nehme).

 Figs. 6a & b: Pre-op radiograph of a maxillary first molar presenting with periapical periodontitis with a forgotten canal in the mesiovestibular root (6a). Post-op radiograph after filling removal with the Remover, cleaning and shaping with the 2Shape and apical finishing with the F40 (0.40 tip and 4 % taper) in palatal and disto-buccal canals (6b) (© Walid Nehme).

About the Author Prof. Walid Nehme is a clinical professor in the department of endodon-tics of Saint Joseph University of Beirut in Lebanon, where he received his DDS in 1988 and MSc in 1994. His academic activities lie in under-graduate and postgraduate education in endodontics and focus on clinical training and practice and supervision of research projects. He runs postgraduate endodontic courses and hands-on courses in the Middle East, Africa, Europe and Canada. Prof. Nehme works in a refer-ral-based practice limited to endodontics in Beirut and Abu Dhabi in the UAE. He is an analyst and opinion leader for clinical trials for endodontic manufacturers and has contributed to the development of new files and devices in endodontics. He has published scientific and clinical articles in peer-reviewed journals nationally and internationally on such subjects as root canal anatomy, instrumentation techniques, NiTi files, irrigation procedures, obturation and retreatment. He is a fellow of the Interna-tional College of Dentists, an international member of the American Association of Endodontists, a council member of the Asian Pacific Endodontic Confederation, a founder member and a past president of the Arab Endodontic Society, and a past president of the Lebanese Society of Endodontology. Additional Authors Prof. Walid Nehme, Dr. Jean-Philippe Mallet, Dr. Bérenger Soulages, Dr. Mathilde Michel, Dr. Franck Diemer

For references and to view on line click here

h en r y sc h e i n .c o m .a u

2 7

ENDODONTIC SOLUTIONS

CALMIX™ BETTER BY DESIGN

Dental Products Australia

CALMIX from Ozdent is an improved calcium hydroxide medicament paste for endodontics, for use as an inter-appointment dressing, as well as for pulp capping and apexification.

CALMIX is better by design, having a unique composition that is optimised around (1) effectiveness against highly resistant bacteria and fungi, (2) improved biocompatibility for soft tissues, (3) optimised viscosity for direct delivery into the apical root canal system through ultrafine tips, (4) improved removability by irrigation, and (5) enhanced radiopacity for ease of detection on radiographs. To achieve all of these improved performance characteristics, CALMIX uses a unique, patent-protected solvent that enhances the release of hydroxyl and calcium ions.1 The underlying physical chemistry behind CALMIX draws on the conceptual framework around non-aqueous solvents and super alkaline pH materials that have been developed for particular industrial applications.2 Prior to CALMIX, this type of technology had never been used in dentistry. Time for a change Traditional calcium hydroxide pastes for endodontics date back to the 1920s. These use water as the solvent, to which is added a thickener such as carboxy methylcellulose, and a radiopaque agent. Unfortunately, the low solubility of calcium hydroxide in water limits the maximum pH to 12.7, which further restricts the total release of hydroxyl ions that are responsible for the antimicrobial actions.3 In fact, with traditional calcium hydroxide pastes, buffering of the pH by dentine greatly reduces the concentration of hydroxyl ions4 and

2 8

compromises the overall effectiveness when faced with the challenge of Enterococcus faecalis, a bacterial species which can survive at highly alkaline pH conditions – up to pH 11.5.5,6 Release of ions Hydroxyl ions penetrate into biofilms within the root canal system and into the dentine tubules, where they provide bactericidal and fungicidal actions.7 Unlike antibiotics and antifungal drugs, resistance to hydroxyl ions (high pH) cannot occur. When hydroxyl ions are released, calcium ions are also released. These contribute to hard tissue repair which is important in situations such as vital pulp capping and apexification. Effectiveness CALMIX was designed to address the challenge of bacteria such as Enterococcus faecalis and fungi that are very difficult to inactivate, and also to give actions that penetrate deep into dentine tubules. This protected location within the dentine increases the challenge for inactivating bacteria and fungi.8 By employing a novel biocompatible solvent material as the vehicle, it was possible with CALMIX to greatly improve the release of hydroxyl ions. In choosing the solvent, a range of materials were evaluated in terms of their physical characteristics as well as their chemical interactions with calcium hydroxide.

ENDODONTIC SOLUTIONS

Figure 1: (Top Left) Calmix placed as an intracanal medicament in the mandibular second molar provides excellent radiopacity for easy detection. (Bottom Left) Clinical photograph showing the presence of a middle mesial canal (arrow). (Right) Calmix is readily identifiable in 3D imaging showcasing that there are three mesial canals, because of the presence of a mid-mesial canal in this case.

CALMIX uses polyethylene glycol (PEG) as the solvent, with two forms of this being combined together to give the ideal physical and chemical characteristics for clinical use.9 PEG in various forms is used in pharmaceutical products because of its high biocompatibility. It was discovered that particular formulations of PEG were a superior solvent for calcium hydroxide, and because of this could dramatically elevate the pH that could be achieved. This improved in the release of hydroxyl ions by several orders of magnitude.10 CALMIX has been shown to be highly effective against Enterococcus faecalis.11 Because of its much higher alkaline pH, it is able to overcome the limitations imposed through buffering by dentine. Unlike traditional water-based calcium hydroxide pastes, it is highly effective against Candida species, which are the most common fungi found in the root canal system.12

Viscosity The physical handling properties of an endodontic medicament are the backbone for its successful use in clinical practice. The base vehicle of CALMIX has been optimised to allow it to flow readily through small diameter syringe tips. Thus, instead of dispensing the material onto a mixing pad and then using a lentulo spiral as a carrier, CALMIX can be delivered directly into the apical third of the canal – where it is most effective - using an ultrafine flexible tip. This is a considerable time saving measure, and it eliminates the risk of lentulo spiral breakages. Removability When used as an inter-visit dressing, ease of removal by irrigation is an important characteristic. Unlike preparations with carboxy methylcellulose, the major form of PEG used in the base vehicle (PEG 400) creates a situation where the material can readily be rinsed from the canal using traditional endodontic irrigants.14 The same PEG 400 compounds is the base vehicle that is used with Ledermix™.

Studies of the release of hydroxyl ions into the dentine of the root have demonstrated that higher pH values are achieved at the root canal walls and through the inner and middle parts of the root with CALMIX than with water-based calcium hydroxide pastes.10 However, the final pH which is achieved on the external root surface is no different, meaning that there is no adverse chemical effect on the cells of the periodontal ligament and no increase in postoperative discomfort.

Radiopacity The level of radiopacity of CALMIX is high, making it readily detectable on radiographs. This allows for easy identification on periapical radiographs and can assist in tracing the root canal morphology on 3D-imaging systems (Figure 1). Using digital radiography methods, the radiopacity of CALMIX has been shown to exceed that of many common water-based calcium hydroxide endodontic medicaments.

Contrary to popular belief, studies using modern methodology have shown that both CALMIX, as well as traditional water-based calcium hydroxide dressings, when left in a root over prolonged periods do not cause any reduction in the physical strength of the root.13 Also, CALMIX does not cause staining of tooth structure.

1 3 0 0

6 5

8 8

2 2

2 9

ENDODONTIC SOLUTIONS

Dental Products Australia

CALMIX™: BETTER BY DESIGN Continued from pages 22-23

Biocompatibility

Leading Australian technology

Standardised cell culture biocompatibility studies have shown that CALMIX causes less irritant and cytotoxic effects on cells than traditional waterbased calcium hydroxide pastes. This makes CALMIX the ideal pulp capping agent for carious pulp exposures and pulpotomy procedures after the complete removal of carious dentine in both adult and children. The high alkalinity provides the aforementioned antimicrobial effects and also causes coagulation of the exposed pulp tissues, thereby providing a scaffold for hard tissue barrier formation.15

CALMIX was invented in Australia, and is made in Australia for the global market. It has been extensively researched in settings from private general dental practice through to specialist endodontic practice. Independent research on CALMIX has been conducted by leading endodontic researchers at multiple Australian universities,10,16,17 as well as at a number of private testing laboratories.

References

INTS

The design and formulation of CALMIX are protected by a range of patents in Australia and other jurisdictions.1 CALMIX is the first commercialised product from a series of hightechnology alkaline dental materials that have been developed for specific clinical applications, and which are also protected by granted patents in Australia and elsewhere.

KEY PO

1. Australian patent 2012/286596. New Zealand patents 620382,

10. Teoh YY, Athanassiadis B, Walsh LJ. Comparison of commercial

calcium hydroxide pastes for prolonged antibacterial effect using aments 709691, and 728268. World patent WO 2013013275. European a colourimetric assessment. Materials (Basel). 2018. 11, 348; ) 2 medic H (O a C patent application EP 12818358.9 al doi:10.3390/ma11030348. PMID: 29495493 xisting n e a ll c a t o n a 2. Walsh LJ. Athanassiadis PEG 400 th influence of aqueous and e ro H The 11.alAthanassiadis B, Abbott PV, George N, Walsh LJ. An in vitro study in th r pB. h e it h w ig y H c it v solvent vehicles on the pH of calcium hydroxide of the anti-microbial activity of some endodontic medicaments and t & Ultra ial actimedicaments. Journal n b e ro d ic lp u m ti of Dental Research 2016;te96(Spec Iss C). P n n a a r th their bases against Enterococcus faecalis biofilms. Australian Dental es Grea B. Non-aqueoususolvents tissuinfluence 3. Walsh LJ, Athanassiadis pH Journal 2010; 55(2): 150-155. to o ter n o ti a of calcium hydroxide products. amJournal of Dental Research e2014; B, Abbott PV, George N, Walsh LJ. An in vitro study tips Less infl ne Athanassiadis in syring fi12. 94(Spec Iss C):193435. pad or nal with of the antimicrobial activity of some endodontic medicaments and their n a o c t u in o d 4. Athanassiadis B, Abbott PV, ry George N, Walsh LJ. Inovitro ce plastudy bases using an agar well diffusion assay. Australian Dental Journal on’t d piral r of the inactivation byW dentine of some antimicrobial 2009; 54: 141-146. p with s endodontic u d e k ic medicaments and theirabases. Australian Dental Journal 2010; 55(3): 13. Kahler SL, Shetty S, Andreasen FM, Kahler B. The Effect of LongE sily p 298-305. 5. Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms 8 involved in the resistance of Enterococcus faecalis to calcium hydroxide. International Endodontic Journal 2002;35(3):221-8. doi: 10.1046/j.1365-2591.2002.00504.x. 6. activity of some endodontic medicaments and their bases against Enterococcus faecalis biofilms. Australian Dental Journal 2010; 55(2): 150-155. 7. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Australian Dental Journal 2007;52(1 Suppl):S64-S82. 8. Walsh LJ, Athanassiadis B. The challenge of endodontic “superbugs” in clinical practice. Australasian Dental Practice 2008;19(3):102-106. 9. Athanassiadis B, Walsh LJ. Aspects of solvent chemistry for calcium hydroxide medicaments. Materials (Basel) 2017, 10(10): 1219. doi:10.3390/ma10101219 PMID: 29065542

term Dressing with Calcium Hydroxide on the Fracture Susceptibility of Teeth. Journal of Endodontics 2018 Mar;44(3):464-469. doi: 10.1016/j. joen.2017.09.018. PMID: 29254817 14. Chou K, George R, Walsh LJ. Effectiveness of different intra-canal irrigation techniques in removing intra-canal paste medicaments. Australian Endodontic Journal 2014; 40(1):21-25. 15. Schröder U, Granath LE. Early reaction of intact human teeth to calcium hydroxide following experimental pulpotomy and its significance to the development of hard tissue barrier. Odontologisk Revy. 1971;22(4):379-95. 16. Cai M, Abbott P, Castro Salgado J. Hydroxyl Ion Diffusion through Radicular Dentine When Calcium Hydroxide Is Used under Different Conditions. Materials (Basel). 2018 Jan 17;11(1):152. doi: 10.3390/ ma11010152. 17. Teoh YY, Athanassiadis B, Walsh LJ. The influence of aqueous and PEG 400 solvent vehicles on hydroxyl ion release from calcium hydroxide medicaments. International Dentistry 2016: 11(4): 42-50. https://espace.library.uq.edu.au/view/UQ:433558

BY EMERITUS PROF LAURIE WALSH AND DR YU-YAO TEOH

3 0

Imp Impo Is Safety ImportantBuy to y Buy 3 3 get get a a Med Me to you? to yo IsImportant Safety Buy Buy 3 3get get a aMedesy MedesyD TIRED OF YOUR SMALL FILES Fro FrF BUCKLING? Important From From $16 $1 to you? to you? Digital De

Important Is Safety to you? ENDODONTIC SOLUTIONS OrO NEW!

NEW!

KOMET PATENCY FILETri IS Auto THE SOLUTION ZX 2 Ingeniously versatile

Thinking ahead. Focuse

Thinking ahead. Focused o

Tri Auto ZX 2

NEW NEW! Tired ofyour yoursm s Tired of

Ingeniously versatile

All All price

What it is:

head. Focused on life.

ead.

Introducin Introducin Introdu

Thinking ahead. Focused on life.

Thinking ahead. A Stainless Steel K-File that is thermally hardened for Focused on life. manual probing Focused on life.

Tri What it:A TriisAu

•

NEW! NEW! yoursmall small files buckling? your files buckling?

All prices are exclusive of GST and freight. To order fax 0508 808 555, available 24 hours

is17 itv 171 171 K-Files K-Files Ingeniously • AWhat Stainless S 173 K 171 171 K-Files K-Files Ingenious (Withcutting (With triangular triangular cutting cutting tip) tip) • A Stainle (With (With square sq (With(With triangular triangular cutting tip) tip) • All Its prices extra strength provides greater leverage which Why it’s spec are exclusive of GST andTofreight. To0508 order fax 0508 808 24 555, available 24 hours All prices are exclusive of GST and freight. order fax 808 555, available hours minimises file buckling • In Its extra strens Why it’s 21/25/31m 21/25/31 In 21/25 In 21/25/31mm In 21/25/31mm lengths. In 21/25/31mm In 21/25/31mm lengths. lengths. lengths. • Resilient • Resilient strength is ideal for working in those hard calcified Instren siz 0s •InItssizes extra In sizes In sizes 006In006 tosizes 080 to sizes 080 In 006 006 to 080 to 080 Why it’s special:

canals in the coronal third

• Sterile packed

• Resilient

25mm 25 uniqu 25mm 25mm also also in in25mm • Sterile packed 25mm also also in in• Includes • Sterile pa bridging optio 090/10 09 Introducing…Komets new Patency File 090/100/110 090/100/110 Introducing ... NEW Patency File by Komet

Introducing…Komets new Patency File • Includes unique “012” size; providing a useful bridging

Tri Auto ZX 2 What is it:Auto ZX 2 Tri What is it: Ingeniously versatile

090/100/110 090/100/110

Packet Packet of 6 of 6

option between the large 50% step-up between sizes “010” and “015”

Packet Packet of 6 of 6

• A Stainless Steel K-File that is thermally hardened for manual probing

bridging • Complete with Packe Po show up on ra between

• Complete show up

• Complete with special depth markings which clearly show Ingeniously versatile • A Stainless Steel K-File that is thermally hardened for manual probing up on radiographs

Why it’s special

between sizes • Includes

21mm - In 5 size

Was $16.90

25mm - In 5 size

• Its extra it’s strength provides greater leverage which minimises file bucklingNOW $14.90 Why special

Thinking 21mmahea - In 5 • Sterile packed • Resilient strength is ideal for working in those hard calcifiedNOW canals in the coronal third25mm - In 5 $14.90 171 171 171 • Includes unique “012” size; providing a useful Thinking a

• Resilient strength is ideal for working in those hard calcified in thefile coronal third • Its extra strength provides greater leverage which canals minimises buckling

• Sterile packed 21mm bridging option between the large 50% step-up between sizes “010” and “015” In 5 sizes & assorted pack K-17521654S1 • Includes unique “012” size; providing a useful bridging the large 50% step-up • Complete withoption specialbetween depth markings which clearly 25mm show up on radiographs between sizes “010” and “015”

HSH3181

171 171 171 Was $16.90

In 5 sizes & assorted pack K-17525654S1

• Complete with special depth markings which clearly show up on radiographs

21mm - In 5 sizes & assorted pack K-175216540__

Tip Diameter ø 1/100 mm

006

008

010

012

015

25mm - In 5 sizes & assorted pack K-175256540__

Thinking Focused on life. 21mmahead. - In 5 sizes & assorted pack K-175216540__ 25mm - In 5 sizes & assorted pack K-175256540__

Tip Diameter ø 1/100 mm

006

008

010

012

015

prices are exclusive of GST and freight. To order fax 0508 to 808 Corporate 555, 24 hours Thinking ahead. All Focused on life. Deal not88 not applicable to available Corporate or Government or Governmen a Orders: Deal 1300 65 22 applicable | www.henryschein.com.au Deals Deals valid valid 03/04 0 h en r y sc h e i n .c o m .a u

3 1

ENDODONTIC SOLUTIONS

HONEST AGILITY FOR THE ENDO

The switch to the new reciprocal file system from Komet Dental is easy, the learning curve steep, because file changes are almost unnecessary. This guarantees safe and economic treatment. Dr Björn Schaper With so many existing Endo files, what about a new File system? I call myself an all-rounder, have been mechanically taking root canal procedures for 15 years, have trained myself through endo curricula and treat myself to daily endodontic cases. That is why I am always open to optimizations, because it is especially the complicated, curved root canals that have to be prepared successfully and safely. Each tooth has its very own root anatomy and I don’t want to have to switch between different files. So, I would like to see a complete portfolio that builds the bridge, i.e. serves all file sizes, but at the same time does not expand. For a long time I worked with rotary, but then I switched to reciprable, because I feel it easier and faster. Both movements have their advantages, but also certain disadvantages in the root canal preparation. The new movement form of Procodile seems to me to unite the best of both worlds now and so the striking green color is not the only one, which sets the system apart from the file market. “Straight Line Access” I used to like to use gates drills for access cavity. But they tend to bend. Those who exert pressure now run the risk of causing debris To go downwards. This cannot happen with the reciprocal opener (Komet Dental). With it I adapt the channel input extension of the reciprocal root canal preparation technique and remain in a weighing form, i.e. no changeover the motor, fewer handles. In this way, the coronally infected tissue is thoroughly removed. In order to compose on a whole length, carefully probe with a 10 hand file. With the PathGlider (Komet Dental) you can make the sliding path mechanical. Due to its taper of .03 it creates a relief for the following in-staffs. This reduces the risk of channel relocations and stages. Now I reach for the procodile files.

3 2

Variable Gutter Percher File If one looks at the core sizes of Procodile, i.e. size, taper, chip space and file core, one can observe the following: The diameter of an apical aperture is at most mostly between the 035 and 045. Procodile operates this spectrum, even reaching size 050, which at a constant taper of .06 would normally result in severe losses in flexibility. Difference with Procodile: Here a complete file spectrum is offered in seven different sizes with a variably tapped cross-section, i.e.: • • •

a constant taper .06 for sizes 020-030 a constant taper .05 for sizes 035-040 and a constant taper .04 for sizes 045-050.

Especially from the size of 040, the hydrodynamic liquid flow is then also secured for a conscientious rinsing process. For me, the bread and butter file for most cases is the 025, i treat strongly obliterated cases with size 020. It is often even possible, in the sense of a l-file system to work through the entire channel. But what does this variably tampered file core mean? At Procodile, the core diameter decreases towards the shaft compared to conventional files. This will increase the chip space. This is an advantage, because what is the use of sharp files if the chip space is not large enough, the abrasion of debris cannot be transported properly and there is blockage? In procodile, the core diameter was reduced in favourof an enlarged chipspace. In my perception, this effect is made when debris is removed clearly noticeable. Thanks to the variably tampered file core, Procodile shows good flexibility. I don’t put much pressure on them, just let them work. So far I have not experienced a single file fracture with procodile, the files follow the originalcalnal course, even the curved ones.

ENDODONTIC SOLUTIONS

8 | Procodile 8 | Procodile 8 | Procodile

Conclusion

Procodile. Procodile. The system. Procodile. The system. The system.

Procodile works in all common left-facing reciprocal drives. This compatibility makes the changeover easy, it is not associated with expensive new purchases. Procodile dab ei supports meto implement a safe and error-free root 8 | Procodile 8 | Procodile canal treatment even with curved root canals. A change over to the file system is easy, the learning cure is fast. That is why I see it mainly in the hands of the all-rounder, whocan reach his goal safely and in economic terms.

Procodile files

with matching taper .06 Procodile files with matching Procodile filestaper .06 PR0C6L25.204.020

with matching taper .06

Procodile. Procodile. The Thesystem. system.

10000666v001_BRO_EN_Procodile_Endo.indd 1

06.09.19 10:19

PR0C6L25.204.020 PR0C6L25.204.025 PR0C6L25.204.020

Procodile Paper points

Procodile Gutta percha points

PR0C6L25.204.030 PR0C6L25.204.025

PPPR06.000.S1 Contents: 30x 025, 10x 030, 10x 035, 10x 040 Procodile Paper points

Contents: 30x 025, percha 10x 030,points 10x 035, 10x 040 Procodile Gutta

PR0C6L25.204.030 Procodile files Procodile files with matching taper .06 withPR0C6L25.204.030 matching taper .06 Procodile files

PPPR06.000.020 PPPR06.000.S1 Procodile Paper points Contents: 30x 025, 10x 030, 10x 035, 10x 040 PPPR06.000.025 PPPR06.000.S1 PPPR06.000.020 PPPR06.000.030

PR0C6L25.204.025

with matching taper .05 PR0C6L25.204.020 Procodile files PR0C6L25.204.020 with matching Procodile filestaper .05 PR0C5L25.204.035 PR0C6L25.204.025

PR0C6L25.204.025 with matching taper .05

PR0C5L25.204.035

PR0C6L25.204.030 PR0C6L25.204.030 PR0C5L25.204.040

PR0C5L25.204.035

PR0C5L25.204.040

Procodile files Procodile files with matching taper .05 files Procodile withPR0C5L25.204.040 matching taper .05

with matching taper .04 Procodile files PR0C5L25.204.035 PR0C5L25.204.035

with matching Procodile filestaper .04

GPPR06.000.S1

GPPR06.000.020 GPPR06.000.S1 Procodile Gutta percha points

Contents: 30x 025, 10x 030, 10x 035, 10x 040 GPPR06.000.025

GPPR06.000.S1 GPPR06.000.020

GPPR06.000.030 Contents: 30x 025, 10x 030, 10x 035, 10x 040

Contents: 30x 025, 10x 030, 10x 035, 10x 040

PPPR06.000.025 PPPR05.000.035 PPPR06.000.020 PPPR06.000.030 PPPR05.000.040 PPPR06.000.025 PPPR05.000.035 PPPR04.000.045 PPPR06.000.030 PPPR05.000.040 PPPR04.000.050 PPPR05.000.035 PPPR04.000.045 Procodile Paper points PPPR05.000.040 Procodile Paper points PPPR06.000.S1 PPPR04.000.050 PPPR06.000.S1 PPPR04.000.045 Contents: 30x 025, 10x 030, 10x 035, 10x 040

Contents: 30x 025, 10x 030, 10x 035, 10x 040

PPPR06.000.020 PPPR04.000.050 PPPR06.000.020 PPPR06.000.025 PPPR06.000.025 PPPR06.000.030 PPPR06.000.030 PPPR05.000.035 PPPR05.000.035 PPPR05.000.040 PPPR05.000.040 PPPR04.000.045 PPPR04.000.045 PPPR04.000.050 PPPR04.000.050

GPPR06.000.025 GPPR05.000.035 GPPR06.000.020 GPPR06.000.030 GPPR05.000.040 GPPR06.000.025 GPPR05.000.035 GPPR04.000.045 GPPR06.000.030 GPPR05.000.040 GPPR04.000.050 GPPR05.000.035 Procodile Gutta percha points GPPR04.000.045 GPPR05.000.040 Procodile Gutta percha points GPPR06.000.S1 GPPR04.000.050 GPPR06.000.S1 Contents: 30x 025, 10x 030, 10x 035,GPPR04.000.045 10x 040 Contents: 30x 025, 10x 030, 10x 035, 10x 040

GPPR06.000.020 GPPR06.000.020 GPPR06.000.025 GPPR06.000.025 GPPR06.000.030 GPPR06.000.030 GPPR05.000.035 GPPR05.000.035 GPPR05.000.040 GPPR05.000.040 GPPR04.000.045 GPPR04.000.045 GPPR04.000.050 GPPR04.000.050

GPPR04.000.050

PR0C4L25.204.045

PR0C5L25.204.040 with matching taper .04 PR0C5L25.204.040

PR0C4L25.204.045 Procodile files PR0C4L25.204.050 Procodile files PR0C4L25.204.045 with matching taper .04 with matching taper .04

PR0C4L25.204.050

Available in the lengths 21 mm, 25 mm and 31 mm PR0C4L25.204.045 PR0C4L25.204.050 PR0C4L25.204.045 (6 files per blister pack) Available in the lengths 21 mm, 25 mm and 31 mm PR0C4L25.204.050 (6 files per blister pack) PR0C4L25.204.050

PPSPR06 Procodile paper points packed in blister packaging. 1 3 0 Procodile 0 6 5 8paper 8 2points 2 PPSPR06 120x 025, 20x 030, 20x 035, 40x 040 Contents: packed in blister packaging.

DR. BJORN SCHAPER Dentist Detmold Germany

3 3

ENDODONTIC SOLUTIONS

RELIABLE OBTURATION EXCELLENT PREDICTABLE RESULTS

CLINICAL CASES

Clinical images courtesy of Dr Kurien Mamootil

I have been using the B&L alpha and Beta units as part of my obturation regime for the past 5 years now. My standard obturation technique is a matched cone vertical compaction technique. The Alpha unit is used to warm the matched cone to approximately 5-6mm short of the working length and soften the remaining GP to allow for adaptation to the canal space. Once the apical plug is compacted the Beta unit will quickly fill the remaining canal space effectively and efficiently. The alpha unit accommodates tips of various sizes to allow for deep penetration of the canal space, even in situations of conservative canal preparation. Heat is delivered instantaneously at the touch of a button and the unit also cools very quickly. This means less risk of inadvertent injury to the patient. For the Beta unit I prefer the 25G needle to deliver thermoplastic GP right onto the apical plug. Backfilling is quick and easy, even in irregular canal spaces. Manual delivery allows for maximum tactile feedback. Both units are cord free making them ergonomically friendly.

DR KURIEN MAMOOTIL BDSc. (Melb), GradDipClinDent (Melb), DClinDent (Melb), FRACDS Endodontist - Southern Dental Specialists

3 4

CHANGING PARADIGMS: RESTORATIVE ENDODONTICS

A revolutionary concept shifting our approach to root canal therapy We have witnessed only a handful of truly revolutionary changes in dentistry. A revolutionary concept doesn’t necessary fulfill an unmet need it actually changes our thinking and the way we approach a problem. It makes us question currently accepted standards and often begins a new era of technology and techniques. True paradigm shifts in clinical care require reproducible scientific and clinical evidence and often take years to develop. Case in point, the migration of our profession from the use of amalgam fillings with retentive forms to bonded composites with minimally invasive preparations. Endodontics has evolved over the past half century. However, to a large degree obturation has remained the same. The physical and chemical properties (limitations) of historical materials (specifically sealers) led to time consuming and inefficient procedures to condense gutta percha in an attempt to minimise the sealer interface. Because previously available sealers would shrink upon setting, the condensation of gutta percha has been considered necessary to minimise the sealer interface between the gutta percha and the canal walls. The techniques required to condense gutta percha (pluggers, spreaders, and carriers) insidiously led to the removal of excessive coronal radicular dentin to facilitate compaction. The result has been the weakening of the structural integrity of many endodontically treated teeth, making them more susceptible to fracture.

BC Points™

BC Sealer™

BC Sealer (BUSA, USA) is a premixed medical-grade pure bioceramic sealer that exhibits absolutely zero shrinkage, is hydrophilic, forms hydroxyapitite upon contact with moisture and bonds chemically to dentin. Restorative endodontics is a new biologic standard of care that allows us to “shift” our thinking so that root canal therapy can now be considered an integral part of the restoration of a tooth. Instrumentation can now be limited to a size necessary only to achieve debridement and disinfection. Shaping (especially coronal shaping) is no longer dictated by obturation a revolutionary concept. With the introduction of bioceramic root canal sealers and bioceramic coated gutta percha (BC Sealer™ and BC Points™) we are seeing a revolutionary change in endodontics and restorative dentistry. These advancements have shifted and elevated our thinking allowing us to recognise a new modern biologic standard of care known as “restorative endodontics.” About the Authors Martin Trope, DMD, is clinical professor of endodontics at University of Pennsylvania School of Dental Medicine and maintains a private practice in Philadelphia, Pennsylvania. Ronald E. Goldstein, DDS, a pioneer in modern esthetic and restorative dentistry, maintains a private practice in Atlanta, Georgia.

With the development of a new class of endodontic sealers known as nanoparticle bioceramic cements, we are now looking at a paradigm shift. This change in philosophy mimics that which we have seen in the past with bonded composites replacing amalgam. MARTIN TROPE DMD h en r y sc h e i n .c o m .a u

RONALD E. GOLDSTEIN DDS 3 5

SEPTOJECT AA BIT BIT MORE… MORE…

PAIN CONTROL

The sharpness can see A BIT BIT MORE… Sharpness you SHARPNESS can see The sharpness you can see Ayou MORE… Sharpness you can see SEPTOJECT

BIT MORE… MORE… YOU CAN SEE AA BIT

Every practioner can experience difficulties with the penetration and trajectory of a dental needle, which Every can experience difficulties the penetration of a dental needle, which is oftenpractioner directly related to the pain felt by thewith patient, both at theand timetrajectory of application and afterwards. The is often of directly to the felt by the and patient, both atfor thethe time of application afterwards. The causes these related difficulties for pain the practioner discomfort patient are often and attributable more to causes of these difficulties for the practioner and discomfort for the patient are often attributable more to the dental needle itself than to the application technique.Every practioner can experience difficulties with the penetration the dental needle itself than to the application technique.Every practioner can experience difficulties with the penetration (1)(2) directly related toscan the to pain felta by the patient, both at the An independent study, published in 2005(1)(2) , performed isanoften electron microscope take close look is often directly related to the pain felt by the patient, both at the Excellent tissue penetration achieved with An independent study, published in 2005 , performed an electron microscope scan to take a close look causes ofIt these difficulties for the practioner at seven commonly usedpenetration brands of disposable dental needles. revealed manufacturing defects at and the discomfort for Excellent tissue achieved with causes of these difficulties for the practioner and discomfort Every practioner can experience difficulties with the penetration and trajectory of a dental needle, which at seven commonly brands disposable dental needles. It revealed manufacturing defects at the the dental needle itself than todental the application technique. for t needle point, such can asused burrs, jaggedofdifficulties edges andwith blunt points. a high quality triple-bevel needle with Every practioner experience the penetration and trajectory of a needle, which the dental than to and the application technique. isaoften directly to the painedges feltneedle byand theblunt patient, both at theneedle time ofitself application afterwards. The needle point, suchrelated as burrs, jagged points. high quality triple-bevel with (1)(2) An independent study, published in 2005 , performed an elect is often directly related to the pain felt by the patient, both at the time of application and afterwards. The (1)(2)more to causes of theseand difficulties for the practioner and discomfort for the patient are often attributable polished siliconized cannula An independent study, published in 2005 , performed an electr at seven brands of disposable needles. causes of these difficulties and discomfort for commonly the patientused are often attributable more dental to and siliconized cannula thepolished dental needle itself thanforto the the practioner application technique. at sevenpoint, commonly brands of edges disposable dental needles. I needle such asused burrs, jagged and blunt points. the dental needle itself than to the application technique. (1)(2) OTHER BRANDS needle point, such as burrs, jagged edges and blunt points. An independent study, published in 2005 , performed an electron microscope scan to take a close look High grade surgical steel tubing to Every practitioner can experiencestainless difficulties with (1)(2)the OTHER BRANDS An independent study, published inof2005 , performed an electron microscope scan to take a close look grade surgical stainless steel tubing to atHigh seven commonly used disposable penetration and trajectory of abrands dental needle, which dental needles. It revealed manufacturing defects at the Every practioner can experience difficulties with the penetration and trajectory of a dental needle, reduce risk of breakage (ISO 9626) seven commonly used brands ofedges disposable dental needles. It revealed manufacturing defectswhich at the isat often directly related to the pain felt by the patient, needle point, such as burrs, jagged and blunt points. Every practioner can experience difficulties with the penetration and trajectory of a dental needle, which reduce risk of breakage (ISO 9626) both at the time such ofrelated application afterwards. is often directly to theand pain feltedges by theand patient, both at the time of application and afterwards. The needle point, as burrs, jagged blunt points. OTHER BRANDS is often directly related to the pain felt by the patient, both at the time of application and afterwards. The The causes of these difficulties for the practitioner causes of these difficulties for thegood practioner and discomfort for theBRANDS patient are often attributable more to OTHER mark topatient ensure orientation andBevel discomfort fordifficulties the arethe often attributable causes of these for practioner and discomfort for the patient are often attributable more to Bevel mark to ensure good orientation the dental needle itself than to the application technique. more to the dental needle itself than to the the dental itself than to the application technique.• Excellent tissue penetration achieved with a high of theneedle bevel (1)(2) application technique. OTHER BRANDS An independent study, published in 2005 , performed an electron microscope scan to polished take a close of the bevel quality triple-bevel needle with and look (1)(2) OTHER BRANDS An independent study, published in 2005 , performed an electron microscope scan to take a close SEPTOJECT An seven independent study,used published in 2005(1)(2), siliconized cannula at commonly brands of disposable dental needles. It revealed manufacturing defects atlook the SEPTOJECT at seven commonly used brands of disposable dental needles. It revealed manufacturing defects at the performed an electron microscope scan to take Plastic hub needle point, such ascommonly burrs, jagged edges of and blunt points. • High grade surgical stainless steel tubing to Plastic a close look sevenas used brands needle point,athub such burrs, jagged edges and blunt points. reduce risk of breakage (ISO 9626)

AA BIT BIT MORE… MORE…

A BIT MORE…

disposable dental needles. It revealed manufacturing defects at the needle point, such as burrs, jagged edges and blunt points. This comparative study concluded that among these seven well-known brands period“… the best quality were the Septoject needles from Septodont”.

Sterilized by gamma-Ray Sterilized by gamma-Ray

OTHER BRANDS OTHER BRANDS SEPTOJECT SEPTOJECT

SEPTOJECT • Bevel mark to ensure good orientation of SEPTOJECT the bevel • Plastic hub • Sterilized by gamma-Ray

(1)(2) An independent, comparative study(1)(2) concluded that among seven well known brands This comparative study concluded that among these seven well-known brands. Every practioner cancomparative experience difficulties with the penetration and trajectory of awell dental needle, which An independent, study concluded that among seven known brands This comparative study concluded that among these seven well-known brands. Every practioner can experience difficulties with the penetration and trajectory of a dental needle, which

is often directly related to the pain felt by the patient, both at theNEEDLES time of application and afterwards. The “…THE BEST QUALITY WERE THE SEPTOJECT NEEDLES FROM SEPTODONT” “…THE BEST QUALITY WERE THE SEPTOJECT FROMand SEPTODONT” is often directly related to the pain felt by the patient, both at theNEEDLES time of application afterwards. The “…THE BEST QUALITY WERE THE SEPTOJECT FROM SEPTODONT” causes of these difficulties for the practioner and discomfort for the patient are often attributable more to

This comparative study concluded that among the SEPTOJECT the dental needle itself than to the application technique.This comparative study concluded that among thes

causes of these difficulties for the practioner and discomfort for the patient are often attributable more to SEPTOJECT the dental needle itself than to the application technique. (1)(2) SEPTOJECT An independent study, published in 2005(1)(2) , performed“…THE an electronBEST microscope scan toWERE take a close look QUALITY THElook SEPTOJECT N An independent study, published in 2005 , performed“…THE an electronBEST microscope scan toWERE take a close QUALITY THE SEPTOJECT N atThis sevencomparative commonly usedstudy brandsconcluded of disposablethat dental needles. It revealed manufacturing defects at the among these sevenmanufacturing well-known brands. atThis sevencomparative commonly usedstudy brandsconcluded of disposablethat dental needles. It revealed defects at the needle point, such as burrs, jagged edges and bluntamong points. these seven well-known brands. needle point, such as burrs, jagged edges and blunt points. “…THE BEST QUALITY WERE THE SEPTOJECT NEEDLES FROM SEPTODONT”

“…THE BEST QUALITY WERE THE SEPTOJECT NEEDLES FROM SEPTODONT”

OTHER BRANDS BRANDS OTHER (1) Microscopic evaluation of dental needles. Diego Espinosa Sanchez OTHER BRANDS

This comparative study concluded that among these seven well-known brands. This comparative study concluded that among these seven well-known brands.

(1) Microscopic of dental needles. Diego Espinosa Sanchez ans Roberto evaluation Espinosa Fernandez. University center of Health Sciences. ans Roberto Mexica. EspinosaThe Fernandez. University center N°1206 of Healthdu Sciences. Guadalajara dental surgeon of France 07 avril Guadalajara Mexica. The dental surgeon of France N°1206 du 07 avril 2005. 2005. (2) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa (1) Microscopic evaluation of dental needles. Diego Espinosa Sanchez (2) Assessing needles. Diego Espinosa Sanchez and Roberto Espinosa Fernandez dental .University center of Health Sciences, Guadalajara, Mexico. (1) Microscopic of dental needles. Diego Espinosa Sanchez ans Roberto evaluation Espinosa Fernandez. University center of Health Sciences. Fernandez .University center of Health Sciences, Guadalajara, Mexico. The DENTIST January 2007.66-68 ans Roberto Espinosa Fernandez. University center of Healthdu Sciences. Guadalajara Mexica. The dental surgeon of France N°1206 07 avril The DENTIST January 2007.66-68 Guadalajara Mexica. The dental surgeon of France N°1206 du 07 avril 2005. (1) Microscopic evaluation of dental needles. Diego Espinosa (2) Assessing dental needles. Diego Espinosa Sanchez and 2005. Sanchez ans evaluation Roberto Espinosa Fernandez. University center Roberto Espinosa Fernandez .University center of Health Sciences, (1) Microscopic of dental needles. Diego Espinosa Sanchez (2) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa of Health Sciences. Mexica. The dental surgeon Guadalajara, Mexico. The January 2007.66-68 (1) Microscopic evaluation of dental needles. Diego Espinosa Sanchez ans Roberto EspinosaGuadalajara Fernandez. University center of Health Sciences.of (2) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa Fernandez .University center of DENTIST Health Sciences, Guadalajara, Mexico. N°1206 du 07 avril 2005. Roberto Espinosa Fernandez. University center N°1206 of Healthdu Sciences. Guadalajara Mexica. The dental surgeon of France 07 avril Fernandez .University of Health Sciences, Guadalajara, Mexico. Fiches Septoject.indd France 2 ans 23/12/14 15:42 The DENTIST Januarycenter 2007.66-68 Mexica. The dental surgeon of France N°1206 du 07 avril Fiches Septoject.indd 2 Guadalajara 23/12/14 15:42 2005. The DENTIST January 2007.66-68 2005. (2) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa (2) Assessing needles. Diego Espinosa Sanchez and Roberto Espinosa Fernandez dental .University center of Health Sciences, Guadalajara, Mexico. Fernandez .University center of Health Sciences, Guadalajara, Mexico. The DENTIST January 2007.66-68 Fiches Septoject.indd 1 Fiches Septoject.indd 2 3 6 The DENTIST January 2007.66-68 Orders 1300 65 88 Fiches Septoject.indd 1

“…THE BEST QUALITY WERE THE SEPTOJECT NEEDLES FROM SEPTODONT” “…THE BEST QUALITY WERE THE SEPTOJECT NEEDLES FROM SEPTODONT”

SEPTOJECT SEPTOJECT

Fiches Septoject.indd 2

O r d e r s Orders 1 3 0 01300 6 565 8888 222 2

pressure Comfort: local anesthetics flow Increased flexibility thanks to t pressure PAIN CONTROL

Improved Increased aspiration flexibility thanks to t

Same tissue penetration as a c Improved aspiration (triple bevel and siliconized ca Same tissue penetration as a c Sterilized by and gamma-Ray (triple bevel siliconized ca

SEPTOJECT XL A LARGER BORE A BIT FOR INCREASED COMFORT

MOR

Sterilized by gamma-Ray

Standard Septojec Needle Need

A BIT MORE… Biodentine Biodentine Biodentine

SEPTOJECT SEPTOJECT XLXL ™

™™ ™ ™

For nearly 30 years THE DENTAL ADVISOR has provided the dental profession with concise, accurate, objective, evidence-based information on dental products and equipment. THE DENTAL ADVISOR reports objective clinical evaluations-performed by a team of over 250 practicing clinicians, comprehensive long-term clinical performance studies, and unbiased laboratory testing in Standard Septoject XL every issue of THE DENTAL ADVISOR. Needle Needle

The first and only dentin in a capsule NEW CT SEPTOJECT XL S XL NEW E NEW NEW Septoject XL was clinically evaluated by clinical consultants from THE DENTAL ADVISOR and was rated ++++½ and was also selected as one of the 2011 Preferred Products in the Anesthetics, Injectable category.

For nearly 30 year concise, accurate, equipment. THE D by a team of ove performance studie ADVISOR.

for Aincreased larger boreA for increased comfort comfort l

Reverse the Reverse the Reverse the Reverse the Irreversible! Irreversible! Irreversible! Irreversible! “First ever T IS EVERYTHING Biological nd the right one with Hu-Friedy Bulk Fill” Irreversible Pulpitis • Comfort: larger bore requires less effort to inject even in dense tissues

Comfort: local anesthetics flow with less s effort • to Comfort: larger bore requires lesspressure effort *to • Increased flexibility thankstissues to thinners wall * inject even in dense *

Septoject XL was ADVISOR and was Preferred Com For nearly 30 years THE DENTAL ADVISOR has Products provided

concise, accurate, objective, evidence-based informatio injec Fiches Septoject.indd 3

are evident when you compare theas disposable nical needle Same tissue penetration a clinical needle needles available on the market. predictable outcomes for (triple your littlest patientsand with siliconized Hu-Friedy Stainlesscannula) Steel Pedo Crowns. ula) bevel

T IS EVERYTHING

HSH2482

equipment. THE DENTAL ADVISOR reports objective clin by a team of over 250 practicing clinicians, compre with less Comfort: anesthetics flowneedle with (triple less Com • Same tissuelocal penetration as a clinical Dental Product performance studies, and unbiased laboratory testing inSh Fiches Septoject.indd 3 bevel and siliconized cannula) evaluation program pressure pres ADVISOR. • Sterilized by gamma-Ray choices. Selected v Septoject XL was clinically evaluatedin by theirclinical privatecons pra nners walls Increased flexibility thanks to thinners walls Incre A needle is more than “just a needle” ++++ ½ ADVISOR and was rated and was also sele 2010, Septoject XL Standard Standard XL Preferred Septoject XL Products in the Anesthetics, Injectable categor Because an anaesthetic procedure is so importantSeptoject Improved aspiration Needle Impr The clinicians invo Needle Needle in your practice, every component of that procedure Needle “Best Product 201 must be chosen carefully... and critical differences • Improved aspiration

Sam Dental Product Shopper is an independent organizati (tripl evaluation program of new products in order to help cli

Realizing a needle fit. is more a commodity, quickly discover why dentists favorthat our impeccable Perfect than for your patients. Easy for you. choices. Selected voluntary clinicians conducts a four-we Septodont has developed since 1990 an affiliate Irreversible Pulpitis Irreversible PulpitisSteri Sterilized bytogamma-Ray se when it comes towholly the perfect fit, Hu-Friedy is just right.and manufacturing dedicated developing in their private practice and then report the results to D

Pulpitis high one quality needles. This facility, at theIrreversible cutting edge nd the right with Hu-Friedy Pediatrics Restorative saves pulps EVEN with signs and symptoms Biodentine of technology 200 million needles annually, DENTISTS LOVE OUR STAINLESS STEELproduces PEDO CROWNS: ™

2010, Septoject XL was evaluated by 11 US clinicians. Endodontics

of irreversible pulpitis* The clinicians involved rated Septoject XL at 4.3/5, which ™ saves pulps EVEN with signs and symptoms Biodentine corresponding to 30% of the world production. Biodentine saves pulps EVEN with signs and symptoms predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. ™ of irreversible pulpitis* Moreover, the R&D centre has led to the introduction As the first all-in-one biocompatible and bioactive substitute, saves pulps EVEN with signs and symptoms Biodentine Ideal height and mesio-distal width “Best Productdentin 2010”. of irreversible pulpitis* quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. ™ brings one-of-a-kind benefi ts for the treatment of ™ dentin wherever it’s damaged. Biodentine ™ fully replaces Biodentine of breakthrough such as the first dental XL needles of irreversible pulpitis* Forfit, vital pulp se when it comes the perfect Hu-Friedy istherapy, just right. bulk-filling the cavity with Biodentine Pre-trimmed andtopre-crimped for simple placement ™ 85%** up to irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine (larger bore) and the first safety device (Ultra brings one-of-a-kind benefi ts Safety for the treatment of Biodentine makes your procedure better, easier faster: /2016 20:17 ™ ™CROWNS: helps Biodentine up to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation DENTISTS LOVE OUR STAINLESS STEEL PEDO Accurate occlusal anatomy that matches the tooth brings one-of-a-kind of remineralization of dentin, preserves the pulp Biodentine Plus) totoavoid needle stick injuries. up 85%** of natural irreversible pulpitis benefi cases:ts for the treatmentthe ™

• Pulp healing promotion: proven biocompatibility andpromotes bioactivity vitality and pulp healing. It replaces dentin with similar

up to Therapy 85%** ofallowing irreversible pulpitis cases:bridge • Vital width complete dentin formation •Pulp Minimally Invasive treatment preserving the tooth structure Vital Pulp risk Therapy allowing complete bridge formation Ideal height and mesio-distal •• Reduced of failure: strong sealing dentin properties biological and mechanical properties. Vital Pulp Therapy allowing complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure • Immediate Pain relief for your patients’ comfort Pre-trimmed and pre-crimped for simple placement Minimally Invasive to treatment preserving thepulp tooth • Only one material fill the cavity from the to structure the top ™ Accurate occlusal anatomy that matches the natural Improving on Biodentine • Similar Minimally preserving the tooth structure • Immediate Pain relief for treatment your patients’ comfort Bio-Bulk fiInvasive llingtooth procedure foras annatural easier protocole mechanical behavior dentin: ideal for bulk fillingclinical implementation, you can now bond

MANAGING

PAIN FOR

• Immediate Pain relief for your patients’ comfort the composite onto Biodentine™ in the same visit and perform the •• Immediate Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole 1 restoration 3 060 months. 6 5 8in8 a 2single 2 Bio-Bulk filling for The fifinal restoration willan beeasier placedprotocole within full session. US ONLINE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk filling procedure for an easier protocole

MANAGING

Fiches Septoject.indd 4

YOUR

3 7

PAIN CONTROL

DENTAPEN THE PERFECT MATCH FOR YOUR PRACTICE

It’s common knowledge that many patients fear going to the dentist and the number one reason is that they fear receiving injections. That fear may be the result of a bad experience or it may be because many injections simply hurt. They hurt because many dentists deliver an entire cartridge of anesthetic in less than 20 seconds creating excessive pressure and local anaesthetics are acidic so delivering anaesthetic quickly creates the stinging sensation. It’s like squirting some lemon juice on a cut. Slowing down an injection allows the anaesthetic to dissipate through the tissue and the body to raise the pH of the anaesthetic thereby reducing the sting. Performing the right injection in terms of type, site and method is the first step toward a pain free patient visit and overall experience. Anaesthesia is a first and essential step for most dental procedures. But dentists face a variety of issues when using a traditional syringe such as: adhering to the recommended injection time (1milliliter in 1 minute), variations in pressure, which can damage tissue and cause discomfort to the patient, and keeping the quality of injections consistent throughout the day. Older dentists, particularly those afflicted with arthritis or tendinitis in the hands will find the automation of local anaesthetic delivery, a very welcome relief. Computer Controlled Local Anesthetic Delivery Systems (CCLADS) were first introduced for use in dentistry in the late 1990s. Over the past 3 decades, they have provided dentistry with a scientifically researched method for the controlled administration of local anaesthetic and, in doing so, a means to help reduce the potential discomfort and anxiety which many patients feared. The first models of CCLADS were either large bench-top units or clumsy handheld cordless units. The Dentapen, is the next generation of electronic syringe or CCLADS. It was released in to the US market a few years ago and to Australia in 2020. With the Dentapen, the challenges of local anaesthetic delivery are greatly reduced from both the dentist’s and patient’s perspective. Like its predecessor CCLADS’s, the Dentapen’s main feature is the consistent and constant low-

3 8

pressure flow, at the right pace. This gives the dentist the opportunity to focus more on needle positioning and insertion, leading to better control of the injection and a reduction in pain for the patient. Quite simply, this low-pressure constant slow flow is impossible to do with the human hand using a traditional syringe. What makes the Dentapen different from other CCLADS’s is that it is a small, lightweight weighing only 40g, ergonomic, self-contained, cordless, being battery operated, and is simple to use. There is no console, no foot pedals, no tubing, or expensive proprietary disposables which must be used with other CCLADS’s. You can use any dental needle of your choice and any 2.2ml dental anaesthetic cartridge. By using 2 different handles which come with the unit, the Dentapen can be held in two different ways – by the wings, like a manual syringe, or pen-like, for a precise injection during some procedures. Patients find the small, modern look to be less threatening because the Dentapen doesn’t look like a syringe and more reassuring because it is “the latest technology”, helping them to relax. The technology gives you three injection speeds for better management of your injections and two modes (continuous flow or gradual increase flow) which can be used for each speed. Hence, there is plenty of flexibility and control in the way in which you wish to administer the anaesthetic. The 3 speeds are 1ml in 30 seconds, 1 ml in 60 seconds or 1 ml in 90 seconds. The packaging contains 1 electronic syringe driver, 7 cartridge holders, 5 syringe-style finger grips, 2 pen-style finger grips,

PAIN CONTROL

3 non-rechargeable batteries, and 25 disposable protective plastic sleeves. Assembling and operating the Dentapen is simple. My dental assistant sets it up prior to the patient entering the treatment room. We use the plastic sleeves to cover the entire unit up to the hub of the needle so that autoclaving the finger grips or cartridge holders is not necessary. I personally have been utilizing the Dentapen in my practice and have found it to be exceptional. It’s lightweight, ergonomic design distinguishes it from virtually every other system that predates it. The entire device fits in the palm of your hand. It is actually smaller and lighter than many traditional syringes. The learning curve for utilizing the Dentapen is relatively short because of its intuitive design. Once the Dentapen is loaded with an anaesthetic cartridge and the power button is pressed, the needle is primed with local anesthetic and is ready to use. After a topical anaesthetic ointment has been applied, the needle is passed through soft tissue in a traditional manner. Some practitioners don’t use the topical anaesthetic but I feel that it shows patients that they are receiving a little bit of extra care and attention with reassurance that I am doing everything possible to make their visit as comfortable as possible. Prior to the initial administration of the anesthetic, you can activate the “ramp-up” button. For inferior alveolar nerve blocks, the anesthetic can be delivered at the faster rate of 1 mL in 30 seconds (purple light). Mental, posterior superior, and infraorbital blocks can be delivered at a medium rate which is 1 mL in 60 seconds (blue light). For these injections, the finger grip is activated, and the CCLAD is advanced until it reaches its intended target, aspirating several times along the way. If an infiltration technique is employed, one can turn off the ramp-up feature after the initial injection has been administered, as subsequent injections are being delivered into an area that has already been anesthetized. The periodontal ligament (PDL) injection, the anterior middle superior alveolar nerve block, and the palatal approach anterior superior alveolar (incisive canal)

nerve block can be performed using the slowest setting (1ml in 90 seconds - green light). In general, because palatal mucosa is keratinized, practitioners often avoid these approaches, as they can be the most pain provoking. Utilizing the Dentapen at the slowest setting, in conjunction with the ramp-up feature, allows the dentist to accomplish these palatal injections with more anaesthetic delivered and virtually pain-free. One of the features which I really like is the automatic aspiration. To aspirate, simply start the flow by pressing down on the finger grip and stop the flow by pressing it a second time. The plunger will then retract a little creating the negative pressure within the cartridge which is needed for aspiration, and then return to its starting position. Every time the flow is stopped, aspiration will occur. Overall patient acceptance of the Dentapen has been outstanding. I explain its use to my patients and it has become a genuine practice builder which distinguishes my practice from others. Although patients can hear the sound of the motor, they universally have had little perception of the actual injection once the initial penetration of the needle has taken place. With rare exception, it has totally replaced the use of a traditional dental syringe. The intuitive design of the Dentapen means there is no steep learning curve. It isn’t necessary to adapt a technique to the device, rather the device allows a dentist to use the same techniques as a standard syringe but improves upon the result. . With a Dentapen, injections are more comfortable for patients, more comfortable for dentists, and give a more consistent and predictable anaesthetic result. The Dentapen from Septodont is the ideal solution for dentists looking to improve their practice by introducing new technology.

BY DR JEFFREY M. KESTENBERG MDSC LDS FRACDS Principal Dentist at Coburg Dental Group

h en r y sc h e i n .c o m .a u

3 9

ORTHODONTIC SOLUTIONS

LEAD YOUR INVISALIGN DIGITAL WORKFLOW WITH THE SMILEVIEW IN-PRACTICE SIMULATION TOOL

The SmileView simulation tool is a new offering from Invisalign that provides patients with a visualisation of how they could look with straighter teeth.

It’s simple but powerful. For patients, it may be that they have always wanted to have straighter teeth but never done anything about it or known where to start. Seeing this simulation could be their starting point, it could be the trigger that gets them to talk to you or to your staff about straightening their teeth with Invisalign treatment. Even if they don’t start the conversation, you will know which patients are interested and as you also see their simulation , what type of outcome they can expect. So, how does it work? It’s simple, each doctor accesses a unique QR code from their Invisalign Doctor Site (IDS) account, and displays this in the practice for patients to scan, take a selfie and be provided with a simulation of how they could look like with straighter teeth – all within 60 seconds. Because the QR is linked to IDS, when patients provide their details for the simulation and opt to share with their doctor, this results in a lead which displays in your IDS, ready for follow up. Whilst it’s primarily designed for use in the practice, there is also the option to use a unique link on social media or in patient communications like emails and SMS reminders to generate a wider pool of leads. The SmileView outcome simulator is a non-clinical tool that helps you generate patient interest and take control of lead generation as the first step in your digital workflow. The SmileView simulation does not show the patient’s actual teeth but is generated by comparing their image against Invisalign’s database of SmileView templates.

These templates are based on the outcomes of millions of patients. The SmileView outcome simulator matches their photo to the closest “before” template and applies the corresponding “after” template to their upper and lower arches to generate their SmileView simulation so that patients can get an idea of what their smile could look like with straighter teeth. Then once a patient converts into Invisalign treatment, you have the option to manage them through their treatment journey with a flexible suite of digital treatment planning tools. For instance, once a patient has seen their SmileView simulation and then commits to treatment, you can then use the planning tools within ClinCheck software to create a personalised treatment plan. It’s here that the ClinCheck In-Face Visualisation tool comes into play as you can see exactly how the final treatment outcome will look like in the patient’s actual face. Once a patient is in treatment, they can be monitored remotely with Invisalign Virtual Care. These Invisalign tools help you get the best results for your patients and to engage them throughout their Invisalign journey. If you are an Invisalign Provider, access your SmileView profile through your IDS account, or talk to your Invisalign representative for more information. For those who aren’t yet an Invisalign Provider, explore more about the benefits of offering Invisalign clear aligners and sign up for an Invisalign Go training course by visiting dentaleducationhub.com. au/courses

Invisalign, the Invisalign logo, SmileView, and ClinCheck, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.

4 0

INFECTION CONTROL SOLUTIONS

INFECTION CONTROL YOUR TRUSTED INFECTION PREVENTION PROFESSIONALS OFFERING EXPERT ADVICE AND PRODUCTS TO MATCH PROTOCOLS.

Welcome to another Dental Solutions Issue, my name is Emma Jones and I am the Infection Control Category Manager for Henry Schein Australia and I am also a credentialled Infection Control Professional (CICP-P). In this issue of Infection Control – Dental Solutions we have encompassed a theme around the various types of testing in the dental setting and brought to light some of the testing requirements and

information for water testing / autoclave testing from Mocom / ultrasonic testing. We have also some interesting articles from Ansell on the Dentaglove latex range and from Hu Friedy on the benefits of using an instrument management system. For those of you that haven’t yet seen or heard I’d like to introduce you to IC Confidential.

� � ON N FF II D D EE N CCO NTTIIAALL

We partner products with infection control protocols in order to help demonstrate the how to the why with these questions.

IC Confidential was created to reach out to customers via a free webinar to demystify some popular infection control questions. Presented by

Emma Jones CICP-P CLICK HERE

What is IC Confidential? IC Confidential is a series of short mini webinars addressing some of the top infection control topics practices face. It bridges the gap between the WHY and the HOW. Often when we attend CPD events we gain a lot of knowledge from a scientific perspective but we sometimes have questions on the HOW to perform certain tasks. And this is what IC Confidential does, we introduce products that you can partner with protocols.

Each month we release a new episode but feel free to go back to view over and over if you wish. Make sure you stay tuned for future episodes to be released at the end of every month. You will also see promotions for these on our Henry Schein Facebook page. Who Can Watch IC Confidential? I’d highly encourage all staff in the practice to watch these, as Infection Control and Prevention should be at the forefront of everyone’s minds to ensure a safe workplace. We have received some great feedback recently from practices who watch these episodes at their monthly staff meeting and document it as a training session in their Infection Control manual.

Where Do I Register? IC confidential is hosted on our Dental Education Hub dentaleducationhub.com.au/category/infection-control You can register and watch for FREE and it’s always available OnDemand.

1 3 0 0

6 5

8 8

2 2

4 1

INFECTION CONTROL SOLUTIONS

CONTROLLING BIOFILM IN DENTAL UNIT WATERLINES

What is biofilm? The term biofilm refers to a collection of microorganisms that adhere to a surface and are surrounded by a protective, sticky slime (known as the extracellular matrix), which is secreted by the bacteria. Biofilms are particularly prevalent in water containing low concentrations of solids and low levels of nutrients. As well as DUWLs, biofilms can be found in streams and rivers, cooling towers, piped water systems and the U-bends of domestic sinks. 80-95% of bacteria in nature exist in biofilms and even the plaque that forms daily on teeth and which causes decay and gum disease, is a type of biofilm. Biofilms form when a few individual bacteria in the planktonic state in water adhere to a solid surface such as the wall of a pipe or tube. Initially surface attraction is weak, but when subsequent bacteria continue to adhere directly to those already attached the adhesion is increased, allowing more planktonic bacteria to attach to the film, building up the level of biofilm which ultimately causes water quality to fall below recommended standards. The problem of biofilms in DUWLs Without treatment biofilm forms in DUWLs relatively quickly allowing microorganisms to multiply and disperse throughout the water system. DUWLs provide a nutrient-rich environment ideal for bacterial colonisation for a variety of reasons:

•

4 2

The low flow rate of water in the narrow small bore tubes used in DUWLs - typically 30ml/min - encourages bacterial adhesion.

•

The water flow is intermittent, causing minimal disruption to the growing biofilm and fresh liquid, such as when using a handpiece or the system is flushed, delivers more nutrients that encourages the growth of new biofilm.

•

The materials used in DUWL tubing are nontoxic - and low toxicity to humans also means low toxicity to bacteria.

•

A warm surgery environment provides an ideal temperature range for bacterial growth.

•

Left untreated, the build-up of biofilm can damage surgery equipment by causing a reduction in water flow and even tube blockage, leading to surgery downtime and additional repair costs.

Protecting patients & the dental team Maintaining water quality is of considerable importance, primarily because both patients and the dental team are regularly exposed to water and aerosols generated by dental equipment. If biofilms are allowed to form in DUWLs, the pathogens settling on the internal wall of the tubing can then enter the oral cavity via high-speed handpieces, ultrasonic scalers, air/ water syringes and mouth rinsing water, exposing patients and staff to microorganisms in fragments of biofilm that can cause illness. Biofilm levels in dental equipment can be minimised by using a range of measures to remove, prevent and control biofilm formation and such measures will help maintain the recommended quality of dental water.

INFECTION CONTROL SOLUTIONS

Purge

Monitoring

If a build-up of biofilm is identified, then purge cleaning should be carried out using a suitable Regulatory Compliance Marked biofilm remover. Bioclear is a pH neutral, odourless, readyto-use solution that requires no mixing. Supplied in single-dose bottles (one bottle is one week’s treatment per chair), Bioclear is simply poured into the chair’s water bottle, drawn through so that it fills the water line and left for a minimum of 12 hours or over a weekend. Once the Bioclear treatment is complete, the line is simply flushed through with fresh water until the water runs clear.

Whichever type of biofilm control you undertake, it is important to regularly monitor the microbial contamination to ensure regulatory compliance. Biological dip slides are an ideal solution, which can be easily used in practice by simply wetting each side of the slide with the output water from each treatment centre. Once left for 72 hours, the dip slides will develop highly visual red spots where contamination is present allowing remedial action to be taken. If the DipSlide is clear that you can be confident that your water management system is working effectively. Regular monitoring of water quality is essential and DipSlide testing should be undertaken quarterly, for each treatment centre.The problem of biofilm has long been an issue in dentistry. By controlling and eliminating the planktonic bacteria in DUWLs from the outset, biofilm simply cannot form, resulting in water that assures compliance with all regulatory guidelines and gives peace-of-mind for dentists who are ultimately responsible for the well-being of patients and staff.

Maintenance Once a DUWL is free of contamination a product that can maintain low levels of biofilm is recommended. Bioclear Daily is a simple and easy-to-use solution which complies with ISO10993 for biocompatibility. Bioclear Daily is introduced directly into the dental unit water feed bottle as a solution in water, acting as a continuous method of controlling the amount of active bacteria in that water. Used daily, it reduces the planktonic bacteria count in water flowing through the unit, minimising the potential for biofilm formation. This solution is designed to prevent biofilm formation on an ongoing basis rather than removing existing biofilm from a system. Exclusive to Henry Schein QD-DS0241 Dentisan Bioclear Daily 1 litre

QD-DS025200 Dentisan Bioclear Kit - shock treatment 12 pack of 200ml bottles QD-DS026 Dentisan Bioclear Dip Slide water testers x 10 slides Walker JT, Bradshaw DJ, Bennett AM, Fulford MR, Martin MV, Marsh PD. Microbial Biofilm Formation and Contamination of Dental-Unit Water Systems in General Dental Practice. Applied and Environmental Microbiology. 2000; 66(8):3363-3367 ADA Guidelines for Infection Control. Third Edition 2015. CDC (2003) Guidelines for Infection Control in Dental Health-Care Settings, page 29.

h en r y sc h e i n .c o m .a u

4 3

INFECTION CONTROL SOLUTIONS

AUTOCLAVE TESTING CONSIDERATIONS

Class B autoclaves In general, Class B autoclaves are compact, user friendly and their performance is comparable to large sterilisation units found in hospital CSSD’s. Most loads can be sterilised in a Class B autoclave, including porous, wrapped, solid, narrow lumen and simple hollow items. The applicable standard for equipment of this kind is 2014 EN13060, which is specific to small steam sterilisers, like the Mocom range. Programmable COMBINED VACUUM + HELIX/ BD TEST option Some of the latest generation of autoclaves feature a Combined Vacuum + Helix/BD Test Cycle. It is easily programmed by the user to start automatically at a scheduled time, like the next workday, or even over a 4-day long weekend (like Easter). The advantage of this unique cycle is numerous, including direct cost savings: • • • • •

4 4

Daily and routine Vacuum* and Helix/BD tests are run consecutively Easily programmed and scheduled to suit workflow Run tests during low cost power periods Labour costs savings @ min 1 hour/day Autoclave can be hot and ready for use at time of clinic opening

How does it work in practice and what can be saved? At the end of the working day, you programme the your autoclave to perform the Combined Vacuum + Helix/BD Test Cycle to start and finish before opening the next day. Upon arriving at the clinic, the autoclave has completed the Vacuum + Helix/BD tests and is hot and ready for your first sterilisation cycle. Assuming your practice is open 220 days/year the minimal potential saving in pure labour hours is ~ 220. *A vacuum test must always be carried out on a “cold” chamber.

Would you like to minimise consumption, reduce waste, speed up your work process? When we think about how to improve productivity and reduce expenses in a dental practice, we do not normally focus on the sterilisation area. However, the use of sterilisation devices and related consumption (I.E. electricity, water, sanitisation), are major items in any budget. Autoclaves can use considerable amounts of water for each sterilisation cycle, not to mention the need to always have bottles of distilled water available. Eliminating water and plastic bottle waste is both a social and a financial commitment. What if we could improve workflow to reduce the work hours needed for human personnel to manage the water supply process?

INFECTION CONTROL SOLUTIONS

In the event, distilled water is stored/produced on-site, it is recommended you regularly check its quality and whether appropriate conductivity levels are adhered to. Such tests may be performed using a TDS Meter also known as a conductivity meter indicating the Total Dissolved Solids of the demineralised water.

Less than 5 litres of water for 50 sterilisation cycles is possible. A new line of dental autoclaves has been designed to allow the use of tap water. The Mocom Supreme is the first closed-circuit autoclave that does not require distilled water - it has been assembled with an in-built demineraliser. Additionally, the unit has a recycling filter that removes organic and inorganic substances via its combination nano ceramic and ion-exchange recirculation filter to purify and recycle the water used.

Traceability software has become part and parcel of any sterilisation process I.E MyTrace. By using this programme, each set of sterilised instruments can be associated to the patient through a bar code. This essential software completes the sterilisation process and provides legal protection to dentists.

With just 5 litres of tap water in the onboard reservoir the Mocom Supreme can achieve 50 sterilisation cycles, significantly reducing water waste and issues related to producing or purchasing and storing demineralised water.

More information related to instruments traceability will be discussed in the next issue of the HS Dental Solutions.

The water quality for autoclaves is critical. Some autoclaves will check the conductivity prior to each cycle and is typically around 15 µS/cm – if not, the onboard H20 monitoring will alert the operator if the water quality is unacceptable.

Y E A R WA R R A N T Y OR 3 0 0 0 C YC L E S

1 3 0 0

6 5

8 8

2 2

4 5

INFECTION CONTROL SOLUTIONS

STERILISATION SCIENCE

Monitor your sterilisation processes with 1 device The gke Orange PCD is a 2-in-1, dual purpose monitoring system that can be used for your Bowie Dick and Helix Test as well as for routine monitoring of all loads. The device can be reused for up to 10,000 cycles - saving you money, and reducing your amount of waste meaning its environmentally friendly! Many other products on the market have a limited lifespan of 250 cycles. The patented stainless steel helix means the gke device is highly durable. It also means that we are simulating the sterilisation challenge posed by stainless steel instruments we are sterilising. The gke Orange PCD simulates the penetration requirements of EN 867-5 and covers you no matter what you are sterilising, be it complex hollow instruments (burs and handpieces), solid instruments (mirrors) or porous loads (gauze). Why can the Orange PCD be used as a Bowie Dick Test and a Helix test? The Australian Standard for Office Based Practice (AS/NZS 4815:2006) is derived from International Standards. EN 13060:2004 and EN 867-5:2001 are the International Standards for Small Steam Sterilisers. EN 867-5 defines the specifications for the test to be used in daily start-up testing of small steam sterilisers.

This test is known as a “Daily Air Removal and Steam Penetration Test” in AS/NZS 4815:2006. A Bowie Dick Test was the first test of its kind for start-up testing of porous loads in large steam sterilisers back in 1963, however this sort of test only makes sense nowadays for porous type loads in large steam sterilisers. As such “Bowie Dick Tests” are only defined in EN 285, which is the International Standard for large steam sterilisers. The terminology Bowie Dick Test | Helix Test | Daily Air Removal and Steam Penetration Test - are all synonymous by definition. They are the mandatory first test we do in our steriliser at start-up in an empty chamber to make sure our steriliser is capable of air removal and steam penetration in our instruments we will be sterilising throughout the day. It is a functionality check of our steriliser. Therefore in accordance with the requirements of EN 867-5 - a test meeting this standard is the only test we must conduct in our empty chamber at start-up. GK-F200-026 GKE Orange PCD Helix B&D test EN867-5 GK-F211-252 GKE Batch Monitoring Indicator Refill Box of 250

The remainder of this article can be viewed on Dental Education Hub

LAUREN KONTUS BSc(EnvSc) Sales and Contracts Manager GKE Australia 4 6

INFECTION CONTROL SOLUTIONS

AUTOCLAVE & ULTRASONIC TESTS

In the context of Autoclave performance testing and inline with the AS/NZS 4815:2006 there are several required tests to be undertaken. When specifically looking at daily tests for autoclaves capable of running B type cycles the following is what is needed:

Please note with tests such as the Henry Schein Helix test, it’s important to throw away the device once you have used the strips, unless your device is a GKE Orange device (for example) which can be reused over 10,000 cycles. Refer to your manufacturer’s instructions for more information.

Vacuum Test or Leak Rate Test

Ultrasonic Cleaner Testing

is a mechanical test by which the autoclave will be tested to prove the vacuum inside is removing the air correctly to achieve sterility. As mentioned on the previous page Mocom have a feature by which you can automate this to be done AND the subsequent air removal and steam penetration test every day (either helix or B&D type test). Check with your autoclave if this is required daily or weekly.

Similar to Autoclave testing as laid out in AS/ NZ 4815:2006 when using an ultrasonic cleaner, you also have to be aware of the performance testing requirements. You should be doing a daily performance test by means of a foil or pencil test. My suggestion - if staff are unaware of what to assess on the foil performance test, perhaps investigate a simpler test to interpret such as: SCT-9TETHULTRAT Hendricks Ultrasonic test kit 60 uses The daily performance test is showing that the ultrasonic cleaner is functioning and working. In order to determine cleaning performance, you can choose to complete a cleaning test by using a test like: GK-C810-101 GKE Small Cleaning Process Indicator Yellow Pack of 320 GK-C810-201 GKE Small Cleaning Process Indicator Green Pack of 320 These tests will go from coloured to white after the cycle has completed to show the cleaning performance. In terms of which colour test you require, head to the products online as it’s determined by the solution you’re using in your cleaner.

Air Removal & Steam Penetration Test This refers to process challenge devices such as the helix and/or B&D type tests. Depending on your load e.g. if you’re going to be sterilizing say gauze you will need to perform a B&D type test using a test such as: GK-F200-026 GKE Orange PCD Helix B&D test or HS9008646 HENRY SCHEIN Bowie Dick Kit cassette & 20 test sheets This B&D type test must be performed prior to the first load of the day to ensure the subsequent cycle can meet the requirements for that porous loads. A Helix test should be completed for non-porous loads which would be solid instruments and hollow instruments (cannulated) such as: HS-9008649 HENRY SCHEIN Helix Test Kit Helix body and 250 sheets

h en r y sc h e i n .c o m .a u

4 7

INFECTION CONTROL SOLUTIONS

AUTOMATED INSTRUMENT CLEANING Ultrasonics vs. Medical Grade Washers

In 1916 The Medical Summary journal reported, “The possibility of the transmission of disease through the medium of dental instruments has probably been considered by every occupant of the dentist’s chair.” One can only assume that healthcare workers were considering that same risk throughout their day at work. Within a dental clinic, one of the most potentially hazardous steps in the reprocessing cycle is the cleaning of contaminated instruments; and yet, in 1976 instruments were still only cleaned manually with a short handled brush, sometimes only disinfected and not sterilized, and then stored unwrapped. It wasn’t until the late 1980’s that Occupational Safety and Health Administration (OSHA) recognized the hazards that healthcare workers were being exposed to and released the first mandatory standard infection control procedures for dentists. This was then followed by the issuing of the final Mandatory Bloodborne Pathogens Standard in 1991. While these were critical steps in protecting healthcare workers from hazards faced in their occupation, OSHA’s sole focus are the employees and their standard does not address patient safety. Thus, to protect both the patient and the healthcare workers, the Centers for Disease Control and Prevention (CDC) issued their first Infection Control Recommendations for dentistry in 1993, and subsequently the first Dental Infection Control Guidelines in 2003. Thankfully infection control guidelines have come a long way since then and, as patients, we trust that everything is being done to protect us from infections and diseases caused by improper reprocessing and cross contamination. We trust that guidelines are being followed and standards of practice are being adhered to. The patient’s safety and that of every healthcare worker in the dental office, needs to be the number one priority.

4 8

Photograph of a patient in a dentist’s chair having dental work (by Lewis Wickes Hine, American, 1874-1940), 1917. Silver print. (Photo by GraphicaArtis/Getty Images)

There are two methods to clean dental instruments: manual and automated cleaning. Manual cleaning of instruments is not recommended because of the risk it presents to the healthcare worker. In both the 2003 guidelines and the 2016 Summary of Infection Prevention Practices in Dental Settings, the CDC recommends using automated cleaner such as ultrasonic cleaners, or medical grade washers “to improve cleaning effectiveness and decrease worker exposure to blood.” However, of the two automated options, which is safer and more efficient? A 2016 study done by the Dental Advisor showed that ultrasonic solutions can become up to 70 times more contaminated over the course of the day when the prepared solution is used several times to clean instruments. Furthermore, the average microbial contamination at the beginning of the day was 2190 cfu/mL (Table 1), which is 83% higher than the EPA regulated microbial levels for potable water.

INFECTION CONTROLSOLUTIONS

This finding suggests that even when changing the ultrasonic solutions regularly there is still residual contamination from previous runs, requiring the ultrasonic chamber to be cleaned thoroughly at the end of each work day. A medical grade washer, on the other hand, uses fresh water and cleaning solution for each cycle. In addition some medical grade washers, such as the SciCan’s HYDRIM units even have a self-cleaning cycle that can be run periodically.

A medical grade washer is also more time efficient. Medical grade automated washers are designed to improve the workflow while protecting healthcare workers and patients. According to DentistryIQ, “the time saved by automated washing compared to ultrasonic cleaning is approximately one hour of labor for every nine procedural set-ups.” Another benefit of a medical grade washer is that most can record cycle data. For example, SciCan’s G4 technology’s automatically stores all the cycle data via USB and online. This feature saves the office time by removing the need to manually log cleaning cycles. Moreover, it provides the office the peace of mind of always being prepared for any audit.

When using an ultrasonic there are still many steps involved in the preparation of instruments, such as pre-soaking and scrubbing instruments to remove any gross debris, loading, unloading, rinsing, inspecting, sorting, and drying the instruments before preparing them to be sterilized. All these steps involve handling the contaminated instruments thereby increasing the risk of being exposed to blood and body fluids, as well as the risk of sharps injuries. This risk increases dramatically when using the ‘pat dry’ method to dry the instruments. Alternatively, when using a medical grade washer, the process only involves loading, unloading, inspecting and preparing the instruments for sterilization. Ultimately a medical grade washer is the safer and more effective option, greatly decreasing microbial contamination and the risk of exposure and injuries.

90,000

81,000

70,000 60,000 50,000 40,000 30,000 20,000

Microbial Contamination (cfu/ml)

80,000

10,000 0

61,000 56,000 38,000

2,920 500

3,600

4,150

Beginning of Day

Sample, Day 1

Sample, Day 2

End of Day

Sample, Day 3

Average

Hydrim M2 under bench Hydrim C 61 table top

LOUISA VON HEYNITZ Product Manager Scican Ltd

1 3 0 0

6 5

8 8

2 2

4 9

INFECTION CONTROL

TRAYS VS CASSETTES: CONSIDERATIONS WHEN PROCESSING DENTAL INSTRUMENTS

By Catherine L. Pawloski, RDH and Marie T. Fluent, DDS

There are two main ways to process and transport dental instruments - process loose instruments in pouches, place onto trays and deliver to and from the operatory; or secure instruments in a locked sterilisation cassette to be packaged, processed and transported to the operatory and back to the sterilisation area. The decision to use trays versuscassettes involves a number of factors, including the occupational safety of dental healthcare personnel (DHCP) such as dental assistants; productivity and efficiency of instrument reprocessing; packaging integrity; professional appearance; and overall cost. Infection control guidelines Prior to the investment in any infection prevention and safety product, dental personnel should first and foremost consider compliance with the ADA Infection Control Guidelines and the Australian Standards for instrument reprocessing (AS/NZS 4815 and 4187). All of these recommend against manual cleaning and recommend steps to minimize handling of loose contaminated instruments.

must also be trained to follow all manufacturer instructions for use (IFU) for specific products. Policies, procedures and manufacturer reprocessing and maintenance instructions for reusable instruments and dental devices must be available in or near the instrument reprocessing areas to ensure that all equipment is used properly and is working correctly. When processing loose instruments, DHCP handle contaminated instruments more often than when using cassettes. This poses more vulnerability, as there is an increased risk for sharps injury and/ or exposure to blood-borne pathogens, despite them wearing heavy duty utility gloves. In contrast, cassettes minimise the handling of loose instruments in all phases of reprocessing. Efficiency and productivity When loose instruments are placed into different pouches, organisation and storage can be compromised. Staff must check each pouch to observe whether it is indeed the correct set-up and whether all instruments are present. As pouches are emptied on to a tray in the clinic, the contents spill out in random order and may even find their way to the floor. In contrast, sterilisation cassettes have

Staff training and safety Proper training of dental personnel who process instruments is important. General training requirements include ways to reduce risk of contracting an illness or injury on the job; policies and procedures for reporting occupational injuries; and obtaining the necessary follow-up medical care. It is necessary to train DHCP on all processing steps, including instrument transport, cleaning, inspection, packaging, sterilisation, monitoring of sterilisation and storage of sterilized items. DHCP

5 0

Figures 1 and 2. Hu-Friedy Infinity Series instrument cassettes.

INFECTION CONTROL

Figure 3. Instruments remain within cassettes during cleaning in thermal washer disinfector units or ultrasonic baths.

Figure 4. Following cleaning, the instruments, still in the cassettes, are packaged, sterilised and stored ready for use..

racks which ensure that instruments are aligned and remain in sequence, ready for use in the clinic. After the procedure, DHCP return the various instruments to their correct location in the cassette and they remain in that place throughout reprocessing.

instrument set-ups. When using cassettes, it is important to ensure that the cassette size is compatible with the size of the washer disinfector, ultrasonic bath and steam steriliser.

Instrument preservation and packaging integrity uring manual processing of loose instruments, individual items can move about freely, causing damage to their tips or to other items in the load. It is common for mouth mirrors to become scratched while being cleaned in an ultrasonic unit and for the tips of explorers and probes to become damaged, distorted or bent. In contrast, in cassettes, all instruments are held securely in place, preventing damage or loss of instruments. Pouches with many loose instruments or instruments with sharp tips are more likely to suffer from a pouch perforation. When this happens, the contents of the pouch are no longer considered sterile and the instruments must be removed and reprocessed. In contrast, instruments in a wrapped cassette cannot compromise the packaging as their sharp tips are securely contained within. Pouches and cassettes may also be compromised due to moisture that remains after sterilizing, or splashes of fluid onto sterilized packages. Dental personnel must keep all instrument packages away from any splashes or other contamination to ensure sterility is maintained during storage.

While it may appear that the use of pouched instruments on trays may be a lower cost approach than using cassettes, there are considerable time and cost savings during instrument processing (in addition to benefits of improved safety, efficiency and productivity). Cassettes are easier to store and provide a more professional and up-to-date appearance. Regardless of which type of delivery systems is used, whether bagged instruments on trays or instruments in cassettes, compliance with infection control guidelines and the safety of staff and patients should remain the top priority. About the authors Catherine L. Pawloski, RDH, currently works in clinical practice in Michigan, USA. She has written articles relating to the topics of infection control in the dental office. Marie T. Fluent, DDS, practised general dentistry for 25 years. She is currently an infection control adviser and has written a range of articles on infection control compliance and antibiotic stewardship in dentistry. Article courtesy of “Inside Dentistry”. Thank you to Prof. Laurie Walsh for editing content to ensure compliance with Australian standards and guidelines.

Additional considerations Cassettes may hold unit dose supplies. These can be added after instrument cleaning, rinsing and drying. Having required supplies such as cotton rolls in the cassette eliminates the need to touch cabinets, drawers and containers during treatment. Both pouches and cassettes are available in a multitude of sizes to accommodate all types of

To request a customised appointment please contact 1300 658 822

h en r y sc h e i n .c o m .a u

5 1

INFECTION CONTROL SOLUTIONS

MICRO-TOUCH DENTA-GLOVE THE GLOVES MADE FOR DENTISTS BY DENTISTS

Gloves are critical personal protective equipment (PPE) used in multiple industries and professions to prevent direct contact between a potential harmful microorganism, chemical, object, solution or surface and the wearer’s hand(s). In healthcare, gloves are used primarily as a barrier to prevent a healthcare worker (HCW) from having direct contact with a contaminated surface, an infectious patient, blood and body fluids and/or harmful solutions or chemicals. As well, patients are protected from contamination by the HCW’s hands when the HCW wears gloves.

Timing of glove use and removal is an important aspect of infection prevention. So too is selection of a glove appropriate for the task. The wide variety of tasks typically required of HCWs range from specific grasping situations, handling of power tools, rapid donning in emergencies, palpation of skin, the need to determine surface temperature and contact with rough and jagged edges of either equipment or bone shards. There are many other tasks requiring different features of gloves. Whilst the clinical situations are diverse the range and performance attributes of commonly available gloves are comparatively limited. Typically, HCWs select gloves according to their fit, elasticity, tactility and ease of donning. Comfort is of special significance to HCWs including surgeons, who typically are required to wear gloves for extended periods. Glove fit and avoiding hand fatigue are critically important in these cases as is the durability of the glove and its ability to withstand operating conditions without tearing, breaking or leaking (Mylon,Lewis, Carre, Martin, & Brown, 2014). Torn or broken gloves are inefficient barriers and potentially predispose the transfer of infectious agents from or to the HCW’s hand or the patient or touched surfaces.

5 2

Glove Standard specifications address characteristics or factors such as: • Performance and efficacy • Biocompatibility with blood, saline and any intended chemical contact • Powder levels • Allergenicity (chemicals and proteins) • Pinhole and Acceptable Quality Level (AQL) • Barrier integrity (tensile strength / elongation) • Length, cuff, size, color, odor, thickness • Human factor, fatigue and donning • Packaging and Labelling; if applicable special labelling claims such as chemotherapy • Shipping Stability and Shelf Life How to select quality gloves: Powder-Free Gloves with trace amounts of residual former-release powder (2 mg or less per glove) and no intentionally added donning powders are commonly referred to as “powder free.” Protein Level Claims Manufacturers who can reliably reduce the levels of latex proteins in their gloves to a known level may make a labelling claim. At present, U.S. Food and Drug Administration (FDA) does not allow a protein labelling statement or claim below the current 50μg/dm2 sensitivity limit of the ASTM Lowry Test Method (D5712).

Use this QR Code to read the full article

PREVENTATIVE SOLUTIONS

MOLAR INCISOR HYPOMINERALISATION

What is Molar incisor hypomineralisation (MIH)? MIH is a common developmental condition affecting primarily one or more first permanent molars.1-3 Central incisors may be affected as well, but this usually occurs to a lesser extent.1 Hypomineralisation of the second deciduous molars (HSPM) or canines may also occur.1-3 MIH enamel presents low level of calcium and phosphate. MIH is characterized by whiteyellow enamel patches and dentine hypersensitivity. Variations in severity exist, ranging from mild opacities to post eruptive enamel breakdown. While MIH affects patients’ quality of life, it also creates treatment challenges, which can lead to ongoing restorations and more complex care.1-4 What causes MIH? Recently published new research findings showed that serum albumin plays a direct role in the pathogenesisof molar hypomin.4 For more info visit: www.ncbi.nlm.nih.gov/pmc/articles/PMC7303361/

An erupting Hypomin first permanent molar showing occlusal breakdown. Images courtesy of Dr Jamie Lucas

Tooth Surface Protection It is particularly important that MIH teeth are looked after carefully to limit problems. Management of MIH teeth should include long-term prognosis, as well as management of the presenting concerns, such as pain.

What are the MIH clinical challenges? • MIH teeth are formed with less mineral, which makes them more prone to break down during chewing and tooth brushing. • Once erupted, MIH teeth may start to break down,even without excess sugars or acids in the diet. • Tooth sensitivity and pain are common, which might lead to poor oral hygiene and therefore, increased caries risk • Difficulty in achieving anaesthesia, which are possibly related to chronic pulp inflammation • Limited cooperation of young patients, due to dental fear and anxiety • Repeated marginal breakdown of restorations, leading to dentine exposure and risk of pulp involvement

1 3 0 0

Completed surface protection using GC Fuji VII.

1. Tooth Surface Protection at the practice a) Reduce hypersensitivity: MI Varnish a 5% NAF varnish containing 2% RECALDENT (CPP-ACP). When MI Varnish is applied, it adheres to the tooth and seals exposed dentine tubules. b) Shield MIH enamel surface: Surface protection with GC Fuji VII or GC Fuji VII EP creates a hardened outer layer which prevents plaque accumulation and facilitates tooth brushing. 2. Tooth Surface Protection at home: daily extra protection Promote the importance of oral hygiene with a fluoride containing toothpaste and application of GC Tooth Mousse or GC Tooth Mousse Plus for daily extra protection.

6 5

8 8

2 2

5 3

PREVENTATIVE SOLUTIONS

SAVACOL MOUTHWASH WITH CHLORHEXIDINE

Inhibits plaque formation and gingivitis

Pre-procedural use

Savacol with chlorhexidine effectively inhibits plaque formation and gingivitis.1

There are more than 600 species of microbes in the human mouth.3 Biomatter dissemination is a concern given high-speed, air driven dental handpieces and scalers produce significant amounts of spatter and aerosol.

Chlorhexidine (CHX) acts against both gramnegative and gram-positive bacteria by interfering with the bacterial cell membrane metabolism. Because dental plaque causes gingivitis which may progress to periodontal disease in susceptible individuals and is pre-requisite for the development of dental caries, chlorhexidine may be a valuable aid in preventing dental disease.

Savacol with chlorhexidine offers a strong antimicrobial action, effectively controlling microbial spread in spatter and aerosol.4 Patients should rinse for 60 seconds to reduce viable bacteria, compared to no rinsing.4,5

A systematic review has demonstrated that the use of 0.12% CHX resulted in a mean reduction of 28% in gingival inflammation and 40% in plaque formation.2

Sreenivasan P and Gaffar A (2002)J Clin Periodontol; 29: 965-974 2 Gunsolley JC (2010) J Dent; 38 (Suppl 1):S6-10 3 Dewhirst F et al (2010) J Bacteriol vol 192 no 19:5002-5017 4 Feres M et al (2010) JADA Vol 141: 415-422 5 Klyn, SL et al (2001) General Dentistry Nov: 648-652

5 4

PREVENTATIVE SOLUTIONS

Post-operative use

No bacterial resistance

Rinsing during surgical procedures, and after scaling and root planing, improves periodontal treatment outcomes.6

Long term clinical studies under real-life use conditions have shown, that even with extended use, there is no increase in microbial resistance to chlorhexidine nor any increase in resistant microflora or adverse alterations to bacteria found in dental plaque.1

After surgical procedures, chlorhexidine reduces gingival signs of inflammation in the healing phase.7 Alcohol Free – same efficacy Savacol Alcohol Free is clinically proven to be as effective as original Savacol in reducing plaque and gingivitis.8

Efficacy of chlorhexidine mouthrinses on plaque formation and gingivitis (adapted from Lorenz et al.)8 Plaque formation

Gingivitis 2.0

1.6

Gingivitis Index

Plaque Index

2.0

1.2 0.8 0.4 0

1.5 1.0 0.5 0

Days Control

Days Chlorhexidine 0.2% with alcohol

Chlorhexidine 0.2% alcohol-free

In a randomised, investigator-blind, placebo-controlled, 3-week clinical study with 90 subjects the effect and safety of an alcohol-free chlorhexidine mouthrinse 0.2% on the development of dental plaque and gingivitis was tested compared to an alcohol-containing chlorhexidine 0.2% mouthrinse.

Feres M et al (2009)J Clin Periodontol; 36:857-867 7 Addy M (2003) The use of antiseptics in periodontal therapy. Chapter 22. In: Lindhe J, Karring T & Lang NP (eds). Clinical Periodontology and Implant Dentistry, 4th edition: 479-481. UK: Blackwell Munksgaard 8 Lorenz K et al (2006) J Clin Periodontol; 33: 561-567 6

h en r y sc h e i n .c o m .a u

5 5

Duraphat DuraphatVarnish Varnish ®

PREVENTATIVE SOLUTIONS

High-fluoride High-fluoride suspension suspension for long for long termterm caries caries protection protection

SEMI ANNUAL VARNISH WITH DURAPHAT

High-fluoride suspension for long term caries protection The varnish forms a film on the tooth surface, which builds a persistent calcium-fluoride layer, providing progressive release of fluoride over several months.

The varnish The varnish formsforms a filmaon film the ontooth the tooth surface, surface, With With 22,600ppm 22,600ppm F- andF-high and high adhesion adhesion Measurement of fluoride content of 3 subsequent enamel layers after a single Colgate Duraphat® whichwhich buildsbuilds a persistent a persistent calcium-fluoride calcium-fluoride layer,layer, properties, properties, even even on moist on moist surfaces, surfaces, a highly a highly 1 Varnish application, according toofFDA procedure providing providing progressive progressive release release fluoride of fluoride over 40: over effective effective fluoride-rich fluoride-rich layer layer is formed is formed on the on the several months. months. enamel, which which is visible is visible ineffective electron in electron microscopy microscopy as as With several 22,600ppm F- and high adhesion properties, even enamel, on moist surfaces, a highly fluoridethick thick layers layers of calcium of calcium fluoride fluoride globuli. globuli. rich layer is formed on the enamel, which is visible in electron microscopy as thick layers of calcium Measurement Measurement of fluoride of fluoride content content of 3 of 3 fluoride globuli. ® ® subsequent subsequent enamel enamel layerslayers after after a single a single Semi-annual Semi-annual Colgate Colgate Duraphat Duraphat Varnish Varnish ® ® Semi-annual Colgate Duraphat® Varnish application overapplication 3 years in 132 children: fluoride content of the Colgate Colgate Duraphat Duraphat Varnish Varnish application, application, application over 3 over years 3 the years in 132 inchildren: 132 children: the 1 the enamel measured 6 months after the 5th application and 2 years after the last application. according according towas FDA to procedure FDA procedure 40: 1 40: fluoride fluoride content content of the ofenamel the enamel was measured was measured 6 months 6 months after after the 5th theapplication 5th application and 2and years 2 years after after the last theapplication. last application.

Colgate Duraphat® Varnish proven integration into tooth enamel1

Longlasting effect of Colgate Duraphat® Varnish application1

6,000

4,000 3,500

4,000 3,000 2,000

Flouride (ppm)

5,000

3,000 2,500 2,000 1,500 1,000

1,000

500 0

Fluoride Fluoride became became chemically chemically bound bound and and stored stored even even in deeper in deeper layers layers of enamel. of enamel. • Fluoride became chemically bound and stored even in deeper layers of enamel.

Fluoride Fluoride enrichment enrichment inhibited inhibited • Fluoride enrichment inhibited demineralization. demineralization. demineralization.

Fluoride Fluoride deposited deposited in enamel in enamel by Duraphat by Duraphat was sustained was sustained over 2 over years. 2 years. • Fluoride deposited in enamel by Duraphat was sustained over 2 years.

1 Sound1enamel Sound enamel fluoridefluoride uptake from uptake professionally from professionally applied applied varnishes, varnishes, Dental product Dental product Testing Testing NumberNumber 07-110,07-110, internal internal report, Colgate-Palmolive report, Colgate-Palmolive Company Company 1 .. enamel .. fluoride uptake from professionally applied varnishes, Dental product Testing Number 07-110, internal report, Colgate-Palmolive Company Sound 22Seppa 2L.Seppa Fluoride L. Fluoride contentcontent of enamel of enamel during treatment during treatment and 2 years and after 2 years discontinuation after discontinuation of treatment of treatment with fluoride with fluoride varnishes. varnishes. Caries Res Caries 18, 278-281, Res 18, 278-281, 1984 1984 Seppa.. L. Fluoride content of enamel during treatment and 2 years after discontinuation of treatment with fluoride varnishes. Caries Res 18, 278-281, 1984

5 6

Duraphat PREVENTATIVE SOLUTIONS

Clinical evidence of therapeutic reliability

The graph review on Collaborat decision-m evidence b Cochrane r high qualit evidence b

Duraphat Varnish ®

Clinical evidence of therapeutic reliability

In the 2002 review on fluoride varnishes, 6 out of 7 studies analysed were done with Colgate Duraphat® Varnish: 1

The graph shows the result of a Cochrane review on fluoride varnishes. The Cochrane Collaboration aims to improve the healthcare decision-making globablly by providing evidence based on reviews of clinical trials. Cochrane reviews have become known for their high quality standards and strict application of evidence based medicine principles.

The only

Patients with mildfluoride to severe dentine hypersensitivity varnish The caries-inhibiting effect of fluoride varnish application in received 3 Colgateregistered Duraphat® applications asVarnish 2 mean reduction of D(M)FS. over 21 days (1 application per visit): a medicine

for caries The mean caries prevention effect in deciduous teeth was 33 prevention

Clinical evidence of therapeutic reliability Flouride varnishes proven for preventing dental caries1

® Varnish proven for Duraphat The graphColgate shows the result of a Cochrane hypersensitivity relief2

review on fluoride varnishes. The Cochrane Collaboration aims to improve the healthcare 3.5 decision-making globablly by providing 3.0 evidence based on reviews of clinical trials. Cochrane2.5reviews have become known for their 2.0 standards and strict application of high quality evidence 1.5 based medicine principles.

Patients w hypersens Varnish ap per visit): 2

Median pain scores by visit

Caries reduction (%)

80 70 60 50 40 30

Effectiv

Onset o

Pain rea almost

1.0 review on fluoride varnishes, 6 out In the 2002 of 7 studies 0.5 analysed were done with Colgate Duraphat® Varnish: 1

20 10 0

In the 200 of 7 studie Duraphat®

Duraph sensitiv

mean

visit 1

visit 2

visit 3

visit 4

Cochrane selection of studies

•

The caries-inhibiting caries-inhibiting effect fluoride varnish varnish application Effective relief for dentine hypersensitivity. 1• Marinho et al.: Fluoride Varnishes for preventing dental caries in children and adolescents (rev The effect of of fluoride inVCC permanent dentition showed a 46% application in permanent dentition showed a 46% 2• Gaffar A. Treating hypersensitivity with fluoride varnishes. Compend Contin Educ Dent 19, 1088-1 Onset of effect from the first application. mean reduction of D(M)FS. mean reduction of D(M)FS.

•

The mean caries prevention effect in deciduous teeth waswithin 33%.21 days.

The mean caries prevention effect in deciduous teeth was 33%.

•

Pain reaction to air stimulus decreased to almost zero

•

Duraphat consistently & significantly reduced sensitivity (p < 0.005).

YOUR PARTNER IN ORAL HEALT

Patients with mild to severe dentine hypersensitivity received 3 Colgate Duraphat® www.colgateprofessional.com.au Varnish applications over 21 days (1 application 1 Marinho VCC et al.: Fluoride Varnishes for preventing dental caries in childrenper and adolescents visit): 2 (review). Cochrane Database Sys Rev. 2002;3: CD002279 2 Gaffar A. Treating hypersensitivity with fluoride varnishes. Compend Contin Educ Dent 19, 1088-1090, 1998 Effective relief for dentine hypersensitivity. 1 3 0 0

6 5

Onset of effect from the first application.

8 8

2 2

Pain reaction to air stimulus decreased to

5 7

colgat

PAEDIATRIC SOLUTIONS

TOOTH PROTECTION AT YOUR FINGERTIPS

GC Tooth Mousse™ provides daily extra protection for people of all ages including children. It contains RECALDENT®(CPP-ACP)* as an active ingredient. GC Tooth Mousse™ can: • Provide EXTRA PROTECTION for teeth • BUFFER dental plaque acid from bacteria in the mouth • PROTECT teeth from acidic foods and drinks

*Nature has developed highly efficient protein systems in saliva, blood and milk that stabiliseand transport calcium and phosphate, which are the fundamental building blocks of our teeth and bones. Cow’s milk is recognized as having the most effective system for delivery of calcium and phosphate. Extensive research over the past 25 years has refined the specific milk peptide which transports these essential minerals to help protect our teeth –casein phosphopeptideamorphous calcium phosphate –otherwise known as RECALDENT®(CPP-ACP).

5 8

PAEDIATRIC SOLUTIONS

Help your patients to look after their teeth by prescribing GC Tooth Mousse GC Tooth Mousse Plus

GC Tooth Mousse™ comes in individual 40g tubes in a variety of delicious flavours. GC Tooth Mousse™ Topical crème with calcium and phosphate Assorted pack 10pcs contains: 2 x Melon, 2 x Strawberry, 2 x Tutti- Frutti, 2 x Mint, 2 x Vanilla, 40g tube (35ml) Single flavour 10 pack: Strawberry, Vanilla or Mint Refill Pack: 1 x 40g tube in each flavour: Melon, Strawberry, Tutti-Frutti, Mint or Vanilla

If symptoms persist, talk to your healthcare professional. Always read and follow the instructions for use. GC Tooth Mousse™ contains CPP-ACP (RECALDENT®) which is derived from cow’s milk. GC Tooth Mousse™ also contains hydroxybenzoates and soybean products. Do not use this product if you have a suspected or proven allergy to milk proteins, benzoate preservatives or soybean products. In case of an allergic reaction: stop 1 use, rinse mouth with water and seek medical advice. RECALDENT and RECALDENT device are trademarks of Mondelez International group used under license. CPP-ACP technology has related patents or patents pending in Australia, New Zealand, Europe, Canada, and USA.

h en r y sc h e i n .c o m .a u

5 9

PAEDIATRIC SOLUTIONS

ARE ELECTRIC TOOTHBRUSHES BETTER FOR KIDS?

Good oral health habits should start early. Dentists recommend that you start brushing your child’s teeth as soon as the first ones appear, using a toothbrush specially designed for their age group and moving up to bigger brushes as they grow. One of the most common questions parents ask is whether electric toothbrushes are better for their children than manual ones. The short answer is: sometimes. Both types of toothbrushes can work just as well for keeping your child’s teeth free from plaque and decay – as long as they’re used properly. But electric toothbrushes with attractive features could motivate more reluctant young brushers and help to keep their teeth healthy. Do electric toothbrushes clean kids’ teeth better? There is no clinical evidence that electric brushes are necessarily better at removing plaque or trapped food from children’s teeth. But in many cases, this depends on the individual child. Some children (and even adults) don’t clean their teeth efficiently using a manual toothbrush, even with guidance from their dentist. An electric toothbrush can make this easier by performing the brushing action for you and is usually recommended by dentists for children whose teeth show signs of poor brushing. If your child prefers a manual toothbrush, make sure it has an angled head to clean those hard-to-reach areas. Don’t forget to replace their toothbrush or swap the head of their electric toothbrush every three months or after an illness. Which is easier to use? One of the advantages of electric toothbrushes is that they can make brushing easier and more convenient, especially for kids. Their rotation and

6 0

stroke action mean the toothbrush is cleaning all the time, with the right speed and power. So as long as it cleans every tooth, parents don’t need to worry that their child isn’t brushing properly. Both types of toothbrushes are available with ergonomically-designed handles that are easy for kids to grip and comfortable to hold. Toothbrushes for young children have wider handles that are easier for small hands to control. Which do kids prefer? If your child is happy to use their toothbrush, they’re more likely to use it properly. Trying out both electric and manual brushes should give you an idea of which one your child is more comfortable with. Some kids find electric toothbrushes appealing, while others may find them uncomfortable or even scary, although this usually changes as they get used to it. Some may prefer the motion of electric toothbrushes that clean their teeth one by one, while others may prefer the back and forth, up and down action of traditional brushing.

PAEDIATRIC SOLUTIONS

Which toothbrush should you choose? The best way to find a toothbrush that your child will be happy to use is to let them choose it for themselves. Take them to the supermarket, chemist or your local dental clinic so they can browse the full range of options and pick out the one they’ll be happiest to use every day. Some electric toothbrushes have features designed to make them even more appealing, such as lights, music and sound effects. As well as encouraging your child to brush, this can also help them brush for the recommended amount of time (two minutes, twice a day). Manual toothbrushes may have fewer bells and whistles, but both types of toothbrushes are available in a wide range of colourful and attractive designs to appeal to kids of all ages. This includes brushes with handles sculpted to look like their favourite characters. When your child finds their favourite toothbrush, they’re more likely to develop good oral hygiene habits that could stay with them for life. Keeping up with your dental appointments every six months will give your child’s dentist the chance to inspect their teeth and to give you any feedback on their brushing technique.

Reference: *Bupa Dental: https://www.bupadental.com.au/blog/article/are-electric-toothbrushes-better-for-kids

1 3 0 0

6 5

8 8

2 2

6 1

PAEDIATRIC SOLUTIONS

WHY USE A BAMBOO TOOTHBRUSH?

In the face of rising environmental concerns, eco-conscious Australians are choosing biodegradable products like the bamboo toothbrush. What’s wrong with plastic toothbrushes? According to the Department of the Environment and Energy, Australia generated a staggering 67 million tonnes of waste in 2016/17 alone. Much of this waste was plastic that couldn’t be recycled and was directed to landfills, contributing to the enormous burden of plastic waste on our planet. Terracycle is able to help if you’re someone who wants to recycle their plastic toothbrushes. Should you use a bamboo toothbrush instead? Switching to a bamboo toothbrush is a simple way to reduce the amount of disposable plastic you use. Aside from the bamboo handle, they’re very similar to traditional manual toothbrushes and are just as effective at removing food particles and plaque from your teeth. Are bamboo toothbrushes just another eco trend? Bamboo toothbrushes have seen a huge surge in popularity in recent years. However, they actually go all the way back to ancient China, where the first bristle toothbrushes were made from bamboo handles and boar hairs. Are bamboo toothbrushes really eco-friendly? Bamboo is biodegradable, so a bamboo toothbrush handle is better for the environment when compared to plastic, non-biodegradable ones. If you use a toothbrush with boar bristles, or remove the nylon bristles first, then you can compost your bamboo toothbrush when you’re finished with it.

6 2

Making small changes to our life style, such as moving away from single use plastics, will have a positive change on the environment we need to protect. Moving from a single use toothbrush to a bamboo toothbrush is a good example. David Attenborough

PAEDIATRIC SOLUTIONS

Choosing a Bamboo Toothbrush Just as you would when choosing a traditional plastic toothbrush, you should choose a bamboo toothbrush with your specific needs in mind. For example, choose a brush with a head that fits comfortably in your mouth and a handle that you can easily grip and manoeuvre. This is particularly important if you’re buying a bamboo toothbrush for children, as they have smaller jaws and limited dexterity. Pay attention to the bristles, too. Ideally, you’ll want to choose a soft nylonbristled brush, but some bamboo toothbrushes are made with coarser boar bristles. These bristles may be too rough for some people and lead to enamel abrasion, sensitivity and gum irritation. To make sure you’re cleaning your teeth effectively, you should replace your bamboo toothbrush as often as you would your plastic toothbrush. The Australian Dental Association (ADA) recommends replacing your brush every three months, or as soon as it shows signs of wear and tear like bent or splayed bristles – whichever comes first. If you’re wondering whether or not a bamboo toothbrush is right for you, it’s always best to ask your dentist.

*This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

h en r y sc h e i n .c o m .a u

6 3

PAEDIATRIC SOLUTIONS

MAKE THEIR START TO LIFELONG HEALTHY HABITS FUN

Philips Sonicare For Kids

Toys SHERMAN

Sonic electric toothbrush

Make it fun

PH-HX6321/03

From Tooth shaped timers, slinkys, emoji stickers, sparkle tooth pencils to wind up monster teeth, these little giveaways are always fun for your little patients at the end of their visit.

Bling Ring

Wind up monster teeth

Interactive sonic power. More fun, better brushing. This Bluetooth enabled toothbrush has an interactive app featuring “Sparkly” who keeps children engaged and helps them brush better and for longer. Children have fun while learning techniques that will last a lifetime. For ages 3+ Sonicare Brush heads for Kids pack of 2 Perfect for small mouths with growing teeth Delivers a safe and more pleasant experience that kids find fun and habit-forming

Tooth Pens

Bendable Toothbrush Guys

6 4

PAEDIATRIC SOLUTIONS

Zooby Prophy Angles YOUNG

Mr Thirsty ZIRC

One Step hands free retraction isolation and high-volume suction in one device. Single use No maintenance, or cleaning. Non-threatening appearance, easy trim to suit small mouths. 10mm adaptor packs (also available in 16mm)

Engage young patients and help transform an ordinary dental visit into a more captivating encounter where paediatric patients don’t just open wide, they open wide with a roar! ...

Pack of 100 Pack of 25 Trial kit also available

Disposable, latex-free prophy angles with a soft web cup to ensure low splatter. They fit all slow speed handpieces and are available in five creative animal designs: Penelope the Penguin,Francesca the Flamingo, Chase the Cheetah, Talon the Tiger and Zoe the Zebra. Box of 100 Assorted characters

ZC-50Z986SM-B10

ZC-50Z986SM10 ZC-50Z98716

Crystal HD Mirrors ZIRC •

YD-575010

Vibrant colours • 40% brighter than rhodium mirrors • Soft grip • Autoclaveable p to 1360C Pack of 12

1 3 0 0

6 5

8 8

2 2

ZC-50Z363-NEON

6 5

PAEDIATRIC SOLUTIONS

MAKE THEIR START TO LIFELONG HEALTHY HABITS FUN 2Tone Disclosing Tablets YOUNG

Caries Detector KURARAY NORITAKE

Plaque disclosing tablets can help children brush better by revealing where plaque is hiding on their teeth. Older plaque will be temporarily stained blue, and newer plaque will be temporarily stained red.

Caries Detector is an excellent means of detecting caries and plays a major role in maintaining and preserving tooth structure. Providing confirmation for the excavation of the demineralized outer tooth structure affected by caries,making it possible to remove caries as completely as possible, secures pulp vitality and preserves healthy tooth structure.

Tablets Pack of 250

Solution 60ml Bottle

• Fast and easy use • Free from side effects • Helps preserve healthy tooth structure • Stains tooth structure red changed by caries. • Does not stain remineralized cariesaffected dentin

The Original

6 6

PAEDIATRIC SOLUTIONS

Teethmate F-1

Clearfil Universal Bond Quick

Teethmate F-1 is a fluoride- releasing, light-cured pit and fissure sealant material with strong adhesive properties.

CLEARFIL Universal Bond Quick is a singlebottle, fluoride-releasing, universal adhesive with the original MDP & AMIDE-based chemistry that provides a unique Rapid Bond Technology.

• High bond strength to enamel • Real chemical bond thanks to MDP monomer • Long -lasting fluoride release with molecular stability • Easy handling • Convenient flow control

This new AMIDE monomer rapidly permeates dentin & enamel which eliminates waiting time & dramatically reduces water absorption. It also reduces technique sensitivity & application time without compromising bond strengths, sealing, or desensitizing. • It’s indicated for use with all etching techniques and light, self, or dual-cure materials. . Universal Use: Can be used for Total-etch, Self-etch and Selective-etch techniques. • New original MDP & AMIDE-based chemistry that provides a unique Rapid Bond Technology. • Works on both wet and dry dentin when using the total-etch technique. • No waiting time in both the total-etch and self-etch modes.

h en r y sc h e i n .c o m .a u

6 7

Material And Methods Group A zero pain, both the anaesthetic flow rate and pressure produces a comfortable pain rating 4-10 (me injection. Researchers have found that the Wand induces less anxiety Pain scores than any other injection method et al, 2001). A pilot study(Kudo of the device used for 20 injections in 18 patients, was 0 carried out by a single clinician, at the Oral and Maxillofacial Surgery The study showed t Introduction ADX Specia Department at City Hospital, Birmingham, in July 2010. 1-3 first and second gro

PAEDIATRIC SOLUTIONS

4-8 Pain scores 0 Surgical procedures included biopsies of lip and tongue in to routine exodontia and surgical removal of wisdom teeth. A two sided78% Fisher’s 1-3 The total number of computer controlled injections was 20, of which for table 1. The 4-8 test The study considered both patient pain ratings for the LA administration and cost.

The Wand is a computer-controlled dental injec for administering local anaesthetic. The flow ra anaesthetic is controlled by the computer. The p both the anaesthetic flow rate and pressure pro injection. Researchers have found that the Wan addition than any other injection method (Kudo et al, 20

A PILOT STUDY OF COMPUTER CONTROLLED DENTAL LOCAL A Pilot Study Of Computer Controlled Dental Local Anaesthesia (STA Wand) ANAESTHESIA Objectives

significant.

6 were I.D nerve blocks, 9 were infiltrations, 3 intraligamentary (PDL), one anterior superior alveolar nerve block and one was a combined infiltration/PDL.

9 infiltrations

We found PDL injections to be a good alternative lingual numbness.

6 I.D nerve blocks

E Beshara*, B Speculand*

R Salama** A Pilot Study Of Computer Controlled Dental Local Anaesthesia (STA Wand) Introduction

E Beshara*, B Speculand* To assess this device with regard to ease of use and patient

Objectives

E Beshera*

A two sided Fisher’s Discussion The patients who w for table 1. The test same appointment significant. Pain scores

The patients who w same appointment comfortable than the thu

Objectives 0 handp oHolding the wand

1-3 4-8 Pain scores 0 Material And Methods Sample size 1-3 was too A pilot study of the device used for 20 injection carried out by a single clinician, 4-8 at the Oral and To assess this device with regard to ease of use satisfaction during a one month period.

anterior superior R during Salama** satisfaction a one month period. (PDL) 1alveolar 3 intraligamentary The Wand is a computer-controlled dental injection device nerve block for administering local anaesthetic. The flow rate of the local Department at City Hospital, Birmingham, in Ju Patients’ responses for pain scores were separated into 3 groups. anaesthetic is controlled by the computer. The precise control of Introduction Results Group A zero pain, Group B pain rating 1-3 (light pain) and Group C both the anaesthetic flow rate and pressure produces a comfortable The study considered both patient pain ratings 14 (78%) administration and cost. patients w pain rating 4-10 (medium to high pain). injection. Researchers have found that the Wand induces less anxiety To assess this device with regard to ease of use and patient than any other injection method (Kudo et al, 2001). patients (22%) Surgical procedures included biopsies ofhad lip and Sample size was too BThe Speculand* R Salama**: Wand is a computer-controlled dental injection device Thea study showed that 100% the wand group was includedcompared in the satisfaction during one month period. There were two of groups of patients; 12 patients the to routine exodontia and surgical removal of w for administering local anaesthetic. The flow rate of the local first and second group. The Wand is much more device with their previous retrospective experience of conventional The total number of computer controlled inject Patients’ responses for pain scores were separated into 3 groups. anaesthetic is controlled by the computer. The precise control of both for 9the 6 were I.D nerve blocks, weremachine infiltrations,and 3i dental LA; 3 patients had LA given by the device in one quadrant Studypain) (Wandand STA)Group C Group APain zeroscores pain, Group B pain rating past1-3 (light Control (syringe) both the anaesthetic flow rate and pressure produces a comfortable one anterior superior alveolarpiece” nerve bloc and each “hand co and conventional dental LA in another quadrant at the same (PDL), combined infiltration/PDL. pain rating 4-10 injection. Researchers have found that the Wand induces less anxiety 0 (medium to high 3 pain). 8 appointment. 3 patients were excluded because they had no dental 14 (78%) patients w than any other injection method (Kudo et al, 2001). 1-3 1 4 The delivery of the LA us LA injection in the past. patients (22%) had A pilot study of the device for 20 injections patients, The study showed that 100% of8 the wand groupin was018 included in the was 4-8 used made it difficult to use fo first and second group.at the Oral and Maxillofacial Surgery carried out by a single clinician, 10 Device Disposal of the Wand del Pain 9 scores Birmingham, Study (Wand STA) past Control Department at City Hospital, in July 2010. A two sided Fisher’s exact test(syringe) was conducted on the above groups needle which can6help to 9 infiltrations I.D nerve Syringe 8 is highly for table 1. The 80 test has shown 3a p-value of 0.002 which 1 4 significant. 1-3 7

And Methods A PilotIntroduction Study Of ComputerMaterial Controlled Dental Local Anaesthesia (STA Wand) The Wand is a computer-controlled dental injection for administering local anaesthetic. TheMaterial flow And Methods A Pilotdevice Study Of Computer Controlled Dental Local Anaesthesia E Beshara*, B Speculand* rate of the local anaesthetic is controlled by the R Salama** computer. The precise control of both the anaesthetic (STA Wand) The study considered both used patient ratings for LA flow rate and pressure produces a comfortable A pilot study of the device forpain 20 injections in the 18 patients, was administration and cost. E Beshara*, B aSpeculand* Researchers found that the Wand Conclusion AIntroduction Pilotinjection. Study Of have Computer Controlled Dental Anaesthesia carried out by single clinician, at the Oral Local and Maxillofacial Surgery induces less anxiety than any other injectionDepartment method at City Hospital, Birmingham, in July 2010. R Salama** Surgical procedures included biopsies of lip and tongue in addition (Kudo et al, 2001). (STA Wand) 78% to exodontia and of wisdom Theroutine study considered bothsurgical patientremoval pain ratings for theteeth. LA 4-8

Patients

6 The patients5who were given both types of administration at the A twoappointment sided 4 Fisher’sare exact test wasinconducted on the above groups same presented the table below. for table 1. The test has shown a p-value of 0.002 which is highly 1 anterior su 3 3 intraligamentary (PDL) controlled The computer significant. alveolar ner Pain 2 scores Control (syringe) same visit Study (Wand STA) significantly lower pain sc The Wand is a computer-controlled dental injection device 0 1 1 Most of the patients pref 1 Results administration and cost. 1-3who were given both 0 2 The patients types of administration at the injections in the future. Objective for administering local anaesthetic. The flow rate of the local Objectives 0 The total numbersame of appointment computer injections 4-8 22 in the arecontrolled presented table 9 3There 0 1 pain 3 4 below. 6 20, 10 5 0was 7 of8which were two groups of patients; 12 patients Patients’ responses for scores were separated into groups. anaesthetic is controlled by the computer. The precise control of *Oral & Maxillofa device with their previous retrospective experie 6 were I.D nerve blocks, 9 were infiltrations, 3Pain intraligamentary To assess this device with regard to ease of use and Score Surgical procedures included biopsies of lip and tongue in addition dental LA; 3 patients had Group A zero pain, Group B pain rating 1-3 (light pain) and Group C LA given by the devic both the anaesthetic flow rate and pressure produces a comfortable

E Beshara*, B Speculand* R Salama**

Introduction Introduction

To assess this device with regard to ease of use (PDL), and patient Study (Wandone STA) was a Painwas scores and conventional dental LA in another quadran sametest. visit Control (syringe) one anterior superior alveolar nerve block and 78% Sample size too small removal for statistical patient satisfaction during a one month period. to and surgical of wisdom teeth. appointment. 3 patients were excluded because satisfaction athe one month period. pain rating injection. have foundduring that Wand induces lessroutine anxietyexodontia The is dental injection device 04-10 (medium 1 to high pain). 1 The Wand WandResearchers is aa computer-controlled computer-controlled dental injection devicecombined LA injection in the past. infiltration/PDL. Patients’ responses for pain scores were separated 1-3 0 2 than any other injection method (Kudo et al, rate 2001). Introduction for administering local The of Objectives for administering local anaesthetic. anaesthetic. The flow flow rate of the the local local 10 4-83 groups. 2 0was 14 of (78%) patients wanted theGroup device toinjections used inpain, the future andof 4 Bwhich into Abe Group painincluded rating The total number computer controlled 20, The study showed that 100% ofzero the wand group was in the Material &by Methods Patients’ responses for pain scores were separated into groups. anaesthetic the 339 groups. anaesthetic is is controlled controlled by the computer. computer. The precise control of A Pilot Study OfhadComputer Anaesthesia patients (22%) no preferrence.Controlled Dental Localinto 8 1-3 (light pain) and Group C pain rating 4-10 (medium 6 were I.D nerve blocks, 9 were infiltrations, 3 intraligamentary Discussion first and second group. Group pain) and Group both and pressure produces a comfortable Material And Methods A zero pain, Group B pain rating 1-3 (light pain) and Group CC both the the anaesthetic anaesthetic flow flowTorate rate and 7 assess this device with regard to ease of use and patient (STA test. Wand) A pilot study of theduring device used for 20 injections Sample sizehigh was too small for statistical (PDL),inone anterior superior alveolar nerve block and one was a 6 to pain). satisfaction athe one month period. pain rating 4-10 (medium to high pain). injection. have found Wand induces injection. Researchers have found that E Beshara*, B Speculand* The WandResearchers is a computer-controlled dental injection deviceless anxiety Pain scores Study (Wand5 STA) 18injection patients, was carried out by 2001). a single clinician, at infiltration/PDL. Control (syringe) past combined R Salama** than any method (Kudo et al, 4 than any other other injection method for administering local anaesthetic. flow rate ofinjections the local A pilot study ofThe the device used for 20 in 18 patients, was The study showed that of future thegroup wand 14 (78%) patients the device toNo be100% used in the and 4 group 3 was 0 wanted 3preferrence 8 included the Oral and Maxillofacial at carried out by a singleSurgery clinician, atDepartment the Oral and Maxillofacial Surgery The study showed that 100% of the wand was included in the PDL injec the Wein found Patients’ responses for pain scores were separated into 3 anaesthetic is controlled by the computer. The precise control of A Pilot Study Of Computer Controlled Dental Local Anaesthesia 2 groups. Introduction patients (22%) had no preferrence. ADX Special Trolley and information DVD FREE! Department at City Hospital, Birmingham, in July 2010. 22% included in the first and second group. 1-3 group. 1 4 1 first and City Hospital, Birmingham, in July 2010. The study second Material And Methods Discussion be aCgood altern Group A zero pain, Group B pain rating 1-3 (light pain) 0and to Group both the anaesthetic flow rate and pressure produces a comfortable (STA Wand) 4-8 8 0 The Wand is a computer-controlled dental injection device 0lingual The studypatient considered bothWand patient pain for LA 1 3 4 6 2 numbness. 5 considered both ratings forratings theless LAtheanxiety pain rating 4-10 (medium to high pain). injection. Researchers have found that pain the induces E6Beshara*, B Speculand* infiltrations I.D nerve blocks for 9 administering local anaesthetic. The flow rate of the local administration and cost. Pain Score Study (Wand STA) pastfor pain scores Patients’ responses were(Wand separated into 3 groups. anaesthetic is controlled by the computer. The precise Control control of Pain scores Study STA) past (syringe) R Salama** cost. than any otheradministration injection method et al, 2001). A pilotand study(Kudo of the device used for 20 injections in 18 patients, both wasthe anaesthetic flow rate and pressure produces a comfortable Group A zero pain, Group B pain rating 1-3 (light pain) and Group C rating 4-10 (medium to high pain). injection. Researchers have found 0 that the Wand induces less anxiety preferrence Surgicalout procedures included biopsies lip and and Maxillofacial tongue in addition carried by a single clinician, at the of Oral Surgery The study showed that 100%No of3pain the wand group was88 included in thethe Holding wand than any other injection method (Kudo et al, 2001). Introduction 78% We found PDL injech ADX Special Trolley and information DVD FREE! to routine exodontia and surgical removal wisdom Department atincluded City Hospital, Birmingham, in lip July 2010.teeth. 22% The study showed that 100% of the wand group was included in the A two sided Fisher’s exact test was conducted on the groups Surgical procedures biopsies ofof and 1-3 1 44above first and second group. first and second group. in comfortable than th Prefered the Wand to be a good altern for table 1. The has shown ofControl 0.002 which is highly tongue in addition to routine and surgical The study total number of computer controlled injections wasLA 20, of which The Wand is a computer-controlled injection device 4-8dentaltest 8a p-value 00Study (Wand The considered bothexodontia patient pain ratings for the Pain scores STA) future (syringe) for administering local anaesthetic. The flow rate of the local lingual numbness. 6 were I.D nerve blocks, 0 3 8 9 infiltrations 6 I.D nerve blocks and cost. 9 were infiltrations, 3 intraligamentary anaesthetic significant. Patients’ responses were(Wand separated into 3 groups. is controlled by the computer. The precise Control control of Pain scores Study STA) pastfor pain scores (syringe) removal of administration wisdom teeth. The total number of

Patients

$399

past

(PDL), one anterior superior alveolar nerve block and one was aboth the anaesthetic flow rate and pressure produces a comfortable injection. Researchers have found 0 that the Wand induces less anxiety combined infiltration/PDL. Surgical procedures included biopsies of lip and tongue in addition than any other injection method (Kudo et al, 2001). to routine exodontia and surgical removal of wisdom teeth. A two sided78% Fisher’s exact test

1-3 1 4 Group A zero pain, Group B pain rating 1-3 (light pain) and Group C 4-8 8 0

3pain rating 4-10 (medium to high pain). 8 computer controlled injections was 20, of which the wand h A two sided Fisher’s exact test was conducted on Holding The study showed that 100% of the wand was included in the was conducted on thegroup above groups 1-3 1 4above A two sided Fisher’s exact test was conducted on the abovegroups groups 6 were I.D nerve blocks, 9 were infiltrations, 3 first and second group. in the Wand for tabletypes 1. The test hastest shown ahas p-value of 0.002 which at isa highly comfortable than th the above groups for Prefered table 1. The shown TheDiscussion patients who were both of administration the which is highly test hasgiven shown a p-value of 0.002 which is highly significant. The total number of computer controlled injections was 20, of which for table 1. The 4-8 8 0 future intraligamentary (PDL), one anterior superior alveolar same appointment are presented the table below. 6 were I.D nerve blocks, 9 were infiltrations, 3 intraligamentary p-value of 0.002 which is in highly significant. significant. anterior alveolar nerve block and one was a The patients who were given both types of administration at the nerve block(PDL), andoneone wassuperior a combined We found PDL injections for mandibular posterior teeth extraction same appointment are presented in the table below. combined infiltration/PDL. 1nerve anterior superior to be a good alternative to ID blocks as they avoid labial and infiltration/PDL. 3 intraligamentary (PDL) The patients who were given both types of Pain scores 0 1-3 4-8

9 infiltrations

6 I.D nerve blocks

Results

Control (syringe) past 3 1 8

Study (Wand STA) 8 4 0

lingualsided numbness. A two Fisher’s Control exact test was conducted on the above groups A two sided Fisher’s Control exact test was conducted on the above alveolar nerve Painblock scores Study (Wand STA)groups (syringe) Pain scores Study (Wand STA) same visit (syringe) Discussion for table 1. The has shown is highly 0 testof 1a p-value of 0.002 which 1 The patients administration at the who were given both types administration at the for table 1. The test has shown a p-value of 0.002 which is highly administration at the same appointment are significant. 1-3 0 2 the wand is far more Objectives 0 handpiece with a pen like 1 grasp 4-8 1 oHolding 2 0 same appointment are- palm presented the table below. significant. comfortable than the thumb grasp for ain conventional syringe. same visit

Results Objectives There were two groups of patients; 12 patients

presented in the table below. 1-3 0

2 1 anterior2 superior 4-8 0 (PDL) lingual numbness. 9 infiltrations 6 I.D nerve blocks 3 intraligamentary Painblock scores Control (syringe) STA) same(Wand visit Study (Wand alveolar nerve Study STA) compared the device with their previous retrospective visit Pain scores Control Study STA) (syringe) 14 (78%)same patients visit wanted the device to(Wand be used in the future and 4 0 1 1 The patients who were given both ofpreferrence. administration at the patientstypes (22%) had no 1-3 0 2 Holding the wand handpiece with a pen like grasp is far more Objectives 0 1 1 1 experience of conventional dental LA;patient 3 patients And Methods ogroups 4-8 2 0 same appointment are-12 presented the tablethe below. To assess this device with regard to ease of use and There were Material two of patients; patients compared comfortable the thumb palm grasp for ain conventional Sample sizethan was too small for statistical test. syringe. 22 1 anterior superior 1-3 0 had LA given by3 the device in(PDL) one quadrant and withTo their The Wand is much m satisfaction during a one month period. intraligamentary device previous retrospective experience of conventional assess this device with regard to ease of use and patient A pilot study of the device used for 20 injections in 18 patients, was alveolar nerve block Sample size was too small for statistical test. satisfaction during a one month4-8 period. 00 carried out by a single clinician, at the Oral and Maxillofacial Surgery 2 both for the machin conventional dental LA in another quadrant at the The patients who were given both types of administration at the found PDL toinjections forpatient mandibular posterior teeth extraction To assess thisWe device with regard ease of use and same appointment presented in thetest. table below. size was tooare for statistical satisfaction during monthalternative period. to bea aone good to ID nerve blocksSample as they avoid small labial and

Objectives Objectives

Results

dental LA; Department 3 patients hadBirmingham, LA given by the device in one quadrant at City Hospital, in July 2010. 22% Pain scores Control (syringe) Study STA) 14 (78%)same patients visit wanted the device to(Wand be used in the future and 4each “hand pie and same appointment. Results 3 patients were excluded andbecause conventional dental LApain inratings another at the The study considered both patient for the LA quadrant patients (22%) had no same preferrence. 14 (78%) patients wanted the device to be used intest. the future and 4 Sample size was too small for statistical administration and cost. 0 1 1 Material And Methods they had noregard dentaltoLAease injection the patient past. appointment. 3 patients were excluded because they had no dental To with of useinand To assess assess this this device device with regard There wereSurgical two groups of patients; 12 patients compared patients (22%) no preferrence. procedures included biopsies ofhad lip and tongue in addition Sample size was too small for statistical test. the 1 anterior superior 1-3 0 2 The the m 78% routine exodontia and surgical removal of wisdom teeth. The delivery Wand is of much satisfaction during aa one month period. Objectives 3 intraligamentary LA injection instudy the past. satisfaction during one month There were two groups of(PDL) patients;alveolar 12 patients compared the Atopilot of the device used for 20 injections in 18 patients, was device their previous retrospective experience of conventional nerve block with Material And Methods The Wand is much more expensive than using traditional syringes, 4-8 2 0 made it difficult to carried out by a single clinician,controlled at the Oralinjections and Maxillofacial device with their previous retrospective experience of conventional The total number of computer was 20, ofSurgery which both for the machin both for machine and the disposables. The device costs £2,489.00 at City Hospital, Birmingham, in 2010. 22% dental LA; Department patients had LA given by the device in one quadrant 63 were I.D nerve blocks, 9the were infiltrations, 3July intraligamentary dental LA; 3 patients had LA given by the device in one quadrant (PDL), one anterior superior alveolarpiece” nerve block and£2.50. one was a and each “hand costs 10 and each “hand pie Results and conventional dental LA in another quadrant at the same The study considered both patient pain ratings for the LA combined and conventional dental LA in another quadrant at the same Devicethe future 14infiltration/PDL. (78%) future and 44 of the Wan and administration and cost. patients wanted the device to be used in the appointment. 3 patients were excluded because they had no dental Disposal To assessstudy this device with LA regard toin ease of use and patient The delivery of thehad LA using this device was Discussion timethey consuming 9appointment. patients were excluded because hadwhich no dental injection the patients (22%) preferrence. procedures included biopsies of lip and no tongue in addition A pilot of the device used for 20past. injections in 18 patients, was Surgical3 Sample size was too small for statistical test. needle whichofcan made it difficult to use multiple 78% The delivery theh Syringe exodontia and surgical removal of for wisdom teeth. extractions. satisfaction a one month There wereperiod. groups of patients; 12 patients8 compared the to routine LA injection in the past. Nosyringes, preferrence Material Methods Material carried out during by aAnd single clinician, attwo the Oral and Maxillofacial Surgery 10 The Wand is much more expensive than using traditional device with their previous retrospective experience of conventional We found PDL injections for mandibular posterior teeth extraction DeviceThe total number of computer controlled injections was 20, of which made it difficult to Disposal theinfiltrations, Wand and delivery unit (hand piece) is safer than£2,489.00 the LA blocks as they avoid labial both for 9of the the disposables. The costs to be adevice good alternative to ID nerve and 6 were I.D nerve blocks, weremachine 3 intraligamentary 6 8 9dental Birmingham, Department at City Hospital, in given July by 2010. LA; 3 patients had LA the device in one quadrant 22% 7 at lingual numbness. needle which canpiece” help to reduce needle stick injury. 9 infiltrations 6nerve I.D nerve blocks (PDL), one anterior superior alveolar block and£2.50. one was a and each “hand costs Syringe the same 10 8and conventional dental LA in another quadrant combined infiltration/PDL. used future Device Holding the to wandbe handpiece with ain penthe like grasp is far more and 4 appointment. 3 patients were excluded because 6they had no dental 14 (78%) patients wanted the device Disposal of the Wan

a comfortable ces less anxiety

Group A zero pain, Group B pain rating 1-3 (light pain) and Group C

3pain rating 4-10 (medium to high pain). 8 study showed that 100% of the wand was included in the xact test was conducted on thegroup groups 1The 4above first and second group. in Prefered the Wand as shown ofControl 0.002 which is highly 8a p-value Pain scores future (syringe) past 0Study (Wand STA) 0 1-3 4-8

3 1 8

PAEDIATRIC SOLUTIONS

8 4 0

xact test was conducted the above A two sided Fisher’s exact test on was conducted on the abovegroups groups for tabletypes 1. The test of has shown a p-value of 0.002 which at is highly e given both administration the as shown significant. a p-value of 0.002 which is highly e presented in the table below.

The patients who were given both types of administration at the mandibular posterior teeth extraction same appointment are presented in the table below. D nerve blocks as they avoid labial and

scores Control (syringe) STA) same(Wand visit Study (Wand STA) same visit Study ontrol (syringe) Pain 0 1 1 e given both types of administration at the 1-3 2 with a pen like is far more 0 1 grasp 4-8 1 2 0 e- palm presented the table below. grasp for ain conventional syringe. 0 2 atient Sample size was too small for statistical test. 2 0 Study STA) ontrol (syringe) 14 (78%)same patients visit wanted the device to(Wand be used in the future and 4 patients (22%) had no preferrence. 1 1 mall for statistical test. 0 2 patients, was No0preferrence ofacial Surgery 2

Discussion We found PDL injections for mandibular posterior teeth extraction to be a good alternative to ID nerve blocks as they avoid labial and lingual numbness.

22%

ted the device to be used in the future and 4 epreferrence. in addition mall for statistical78%test. teeth.

e LA

Prefered the

nsive than using traditional syringes, The device costs £2,489.00 Wand in future

as 20, of which disposables. amentary one was a £2.50.

ted the device to be used in the future and 4 his device was Discussion time consuming which preferrence. 14 (78%) patients wanted the device to be used in

ultiple extractions. the future and 4 patients (22%) had no preference.

No preferrence

Holding the wand handpiece with a pen like grasp is far more comfortable than the thumb - palm grasp for a conventional syringe. The delivery of the LA using this device was time consuming which made it difficult to use for multiple extractions. Disposal of the Wand delivery unit (hand piece) is safer than the LA needle which can help to reduce needle stick injury. Conclusion

We found PDL injections for mandibular posterior teeth extraction y unit (hand piece) is safer thantothe LA blocks as they avoid labial and to be a good alternative ID nerve lingual numbness. uce needle stick injury. s

22%

The computer controlled administration of LA resulted in significantly lower pain scores than dental local anaesthetic syringes. Most of the patients preferred to have computerised dental injections in the future.

Holding the wand handpiece with a pen like grasp is far more comfortable than the thumb - palm grasp for a conventional syringe.

No preferrence

* Oral & Maxillofacial Surgery, University Hospitals Birmingham **Statistician, University of Birmingham

22%

TESTIMONIALS of LA resulted in than dental local anaesthetic syringes. d to have computerised dental “The advantage of THE WAND as a pediatric dentist that treats children and disabled adults is that the patient receives

r inistration ck

Prefered the Wand in future

local anesthesia quickly, painlessly, and I don’t have to worry about the patient going home and biting their lip or tongue due to the numb feeling.”

ared the

Surgery, University Hospitals Birmingham The Wand is much more expensive than using traditional syringes, conventional Dr.for Fred Margolis both the machine and the disposables. The device costs £2,489.00 **Statistician, University of Birmingham ne quadrant

e same had no dental

Device Syringe

and each “hand piece” costs £2.50. Pediatric dentist in IL, author,

and teacher at the University of Illinois and Loyola University

The delivery of the LA using this device was time consuming which made it difficult to use for multiple extractions.

Prefered the Wand in future

…”minimizing disruptive behavior [caused bythan stress Disposal of the Wand delivery unit (hand piece) is safer the and LA needle help to reducegetting needle stick injury. don’twhich evencan know they’re an injection.”

fear] in the pediatric patient is a major benefit because they

Dr. William H. Lieberman Practicing dentist in NJ, Associate Clinical Professor, NYU, and past president of the American Society of Conclusion Dentistry for Children and trustee for the American Academy of Pediatric Dentistry

The computer controlled administration of LA resulted in ns for mandibular posterior teeth extraction significantly lower pain scores than dental local anaesthetic syringes. Most of the patients preferred to have computerised dental ve to ID nerve blocks as they avoid labial and injections in the future.

*Oral & Maxillofacial Surgery, University Hospitals Birmingham **Statistician, University of Birmingham

dpiece with a pen posterior like graspteeth is far extraction more1 3 0 0 6 5 ns for mandibular

8 8

2 2

6 9

PAEDIATRIC SOLUTIONS

THE STAINLESS-STEEL CROWN FOR PRIMARY MOLARS OVERUSE? NO, I SAY UNDERUSE.

by Joel Berg, DDS, MS The stainless-steel crown is an important restorative tool in caring for the oral health of children. Although our focus in providing the best oral health care for children is clearly on prevention, unfortunately there are many children who do not seek or obtain oral health preventive care at an early enough age to prevent what can be devastating disease at an early stage of their lives. All who care for children’s oral health see many cases of early childhood caries present at the first visit to a dentist. Children as young as 18 months present to pediatric dental centers all over the country each day with severe early childhood caries in need of treatment to avert progression of significant infection. Further, some children initially present with disease only after the infection has spread beyond the teeth causing facial swelling and a potentially life-threatening condition. These children often need to be hospitalized, placed on intravenous antibiotics and must have an incision and drainage performed, along with extraction of the offending tooth, to avoid a dangerous situation. Of course I support medicinal therapeutic methods (these are rapidly evolving but not all fully tested) of halting disease progression and treating the infection. Though, most commonly, presentation is at too late of a stage and the literature supports restorative treatment to eliminate the decayed tooth structure and to preserve the health of the teeth in these very young children. Most children with early childhood caries do initially present (although late after the initiation of caries disease) early enough to manage their disease progression via restorative techniques. Given the pre-cooperative state of these very young children and the lack of cognitive skills to cooperate for a restorative procedure, we must be carefully astute in planning the right care for the child, providing the best care which will be definitive and avert progression of disease. We want any restorative treatment performed on a child to last the life of the primary tooth, to sustain the health of the tooth in the mouth and to provide

7 0

the appropriate maintenance of space to allow the natural transition into the permanent dentition several years later. Based upon the anatomy of primary molars, with the convergence of the buccal and lingual surfaces toward the occlusal surface (from the proximal perspective), and therefore having a small occlusal table, it becomes challenging to place on intracoronal restoration when the decay has spread even a small amount beyond ideal size in the proximal aspect of the tooth. Therefore, restorations placed with amalgam, composite or glass ionomer must be of ideal size, or perhaps slightly larger, to be retained properly and last the life of the tooth. The scientific literature has shown the strong support for the placement of stainless-steel crowns in the event that restorative materials would extend beyond the ideal size, not allowing retention of the restoration, to avoid leakage after the placement of the restoration and subsequent infection. A stainless-steel crown is easy to place once trained to do so, fits well in a primary molar and provides halting progression of caries to allow the tooth to be retained in the mouth until natural exfoliation, and in a healthy state. Unfortunately, we often see placement of large intracoronal restorations in primary molars, which should have had stainless-steel crowns. Large intracoronal restorations can break, causing leakage and subsequent infection. If not placed properly, there is immediate leakage and subsequent infection, which can be very dangerous for the child’s overall health. Stainless-steel crowns require proper local anesthesia, rubber dam isolation and adequate tooth preparation followed by adequate fitting of the crown, which comes in six stock sizes. After fitting, the crown snaps over the buccal bulge of the molar and is retained mechanically along with the adhesive glass ionomer cement. Glass ionomer cement creates a seal between the tooth to which it is bonded chemically, and to the stainless-steel crown to which it is bonded mechanically. This tight seal, along with a well-fitting adapted stainless-steel

PAEDIATRIC SOLUTIONS

crown, will allow the natural contours, occlusion and fit to restore the tooth adequately and retain its presence in the mouth in a healthy state. We often see very large restorations that break down quickly, causing subsequent infection and requiring extraction of teeth or subsequent restoration, subjecting the child to further treatments that would not have been necessary had a stainless-steel crown been placed in the first instance. Therefore it is clear that there is an underutilization of stainlesssteel crowns. We often see in the press where a child has gone to a provider who was inadequately trained to care for children and certainly for their restorative treatment. There must be proper training for the provider in terms of managing the behavior of the child, in the proper venue, in order to provide the best quality care, and to allay anxiety that might otherwise ensue. Often, treatment of a very young child needs to be performed under sedation – or more likely general anesthesia – in order to provide the best conditions of safety, quality of care and attenuation of anxiety, and to allow the proper treatment to be performed in one appointment. After completion of restorative care, focus on preventive care can be presented to the caregivers and child to avoid further decay and affected caries. When we see in the press that a child came out of a dental office with “eight stainless-steel crowns,” the perception is often that the crowns were unnecessarily placed. This is an unfortunate perception in situations where the crowns were necessary, which is often the case in severe early childhood caries. This must be differentiated from situations where stainless-steel crowns are placed when there is no decay. To be clear, a stainless-steel crown is not a preventive employment. It is a restorative material (after having removed the decayed substance from

the tooth) to allow the tooth to be retained in the mouth until its natural exfoliation. If a stainless-steel crown is placed on the tooth because it is suspected the tooth will become decayed, when it is not (yet) decayed, this is indeed inappropriate. This must be distinguished from the clear need for stainless-steel crowns on many primary molars with early childhood caries. Given the inappropriate use of large intra-coronal restorations in primary molars by practitioners who have not had the adequate training to more appropriately place stainless-steel crowns, it is clear there is a need to provide additional training for the general practitioner who intends to see children so he or she can be properly treated with the restorations that will last the life of the tooth, and where the tooth will be retained in a healthy state until its natural exfoliation. If it is not within the skillset of the general dentist, as with any other specialty-focused procedures in dentistry, the child should be referred to a pediatric dentist who has both the training and the access to provide care for children in appropriate venues. I want to be clear that there is more of an underutilization of stainless-steel crowns (regarding preferred use over the large intra-coronal restorations which very often break down quickly) as opposed to an overuse of stainless- steel crowns. Regardless, there is a need for additional training to make sure the care given to children is definitive, provides reduction of anxiety, makes the child and family focused on preventive care and allows for removal of infection and retention of restorations until the natural exfoliation of the teeth in a healthy state.

DR. JOEL BERG 8th Distinguished Professor for Dentistry Washington Dental Service Foundation h en r y sc h e i n .c o m .a u

7 1

PAEDIATRIC SOLUTIONS

PROTECTION OF PERMANENT MOLARS WITH FISSURE SEALANT

by Dr. Jacqueline Esch Date of Original: September 2014 - Espertise Magazine

Especially in paediatric patients with a high risk of caries the use of fissure sealants can be an effective method of caries prevention [1]. By sealing the enamel pits and fissures on the occlusal surfaces of permanent molars with a resin-based material, an impermeable barrier is created between the enamel and the oral environment. The risk of caries development in the particularly vulnerable parts of molar teeth is reduced significantly.

Figure 1 : Initial situation: Mandibular right first molar after the placement of rubber dam.

Since the retention of sealants is better on sound enamel than on questionably carious tooth surfaces [2], we use to seal permanent molars of children who are likely to develop caries a short time after the complete eruption of the teeth. For the first molars the treatment is usually carried out at the age of six to seven. The procedure is explained by means of the following patient case. Clinical case The seven-year-old female patient presented in our practice for paediatric dentistry for one of her regular check-ups and prevention appointments after her permanent maxillary and mandibular first molars had erupted. Due to her high caries risk we decided to seal the fissures with 3M™ Clinpro™ Sealant.

Figure 2 : A rose-head bur is used for fissure preparation: The fissures are opened slightly and the surface is cleaned.

Figure 3 : Alternatively 3M™ Clinpro™ Prophy Powder can be applied to the tooth surface with an air-polishing device to create a clean surface, followed by rinsing with water.

PAEDIATRIC SOLUTIONS

Figure 4 : Application of 3M™ Scotchbond™ Universal Etchant on the enamel surfaces to be sealed. The etchant should be removed after 15 to 60 seconds. Here the exposure time was 20 seconds.

Figure 5 : Situation after removal of the etchant with water and subsequent air-drying.

Figure 6 : Dispensing of 3M™ Clinpro™ Sealant into the pits and fissures of the molar. The pink colour ensures clear visibility and precise control over the location and amount of sealant placed.

Figure 7 : Result: After light-curing the sealant appears white. It provides a barrier that protects the vulnerable occlusal surface from plaque adhesion. For optimal results, the use of a fluoride containing varnish is recommended.

Résumé The described procedure is a quick and effective way of reducing the caries risk in paediatric patients. In order to provide for durable results, the quality of the sealant layer should be assessed on a regular basis and replaced if necessary [3]. NOTE: Clinpro™ Prophy Powder is not available in Australia & New Zealand References

[1] Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington H. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. The Cochrane Database of Systematic Reviews 2008; Issue 4:Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub3. [2] Michalaki MG, Oulis, CJ, Lagouv ardos, P. Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: an in vitro study. Eur Arch Paediatr Dent. 2010 Feb, 11 (1): 26-31. [3] Mejare I, Lingstrom P, Petersson L, Holm AK, Twetman S, Kallestal C, et al. Caries preventive effect of fissure sealants: a systematic review. Acta Odontol Scand 2003;61(6):321-30.

1 3 0 0

DR. JACQUELINE ESCH Specialist Paediatric Dentistry Munich, Germany

6 5

8 8

2 2

PAEDIATRIC SOLUTIONS

PAEDIATRIC FORCEPS DESIGNED SPECIFICALLY FOR CHILDREN AND OPTIMAL CLINICAL RESULTS

Hu-Friedy’s complete line of pediatric forceps provides child-friendly extraction solutions to enhance patient comfort and preserve delicate tissue and bone. These are precisiondesigned specifically for a child’s anatomical tooth structure, ensuring clinical performance and optimal pediatric dental care. Crafted from the finest materials, Hu-Friedy’s extensive line of pedo forceps include several options to suit your clinical preference. Standard Pedo Series The precise, anatomical design assures a firm, accurate grasp of primary tooth and root surfaces for smooth, seamless extractions with a reduced risk of complications or slipping. Hand-crafted from surgical- grade stainless steel, Hu-Friedy’s pediatric forceps resist corrosion to provide superior performance and longevity. Presidential® Pedo Series Similar to the Standard Pediatric Series, the HuFriedy Presidential Forceps are meticulously crafted and finished with a precision hinge, carrying a lifetime warranty against defects in material and workmanship. Rainbow Presidential Pedo Series Hu- Friedy’s Rainbow Presidential Pediatric Forceps feature a unique rainbow of vibrant colors to reduce child anxiety creating a more positive patient experience. The series carries a lifetime warranty against material and workmanship defects.* Kinder Pedo Series The Hu-Friedy Kinder Pediatric Forceps fit easily and comfortably in your hand. Smaller than the Standard Pediatric Forceps, these are easily hidden from a child’s view. Created for small, shallow crowns and conical shaped teeth, the Kinder design requires less force, decreasing the risk of tissue damage and broken crowns.

7 2

Standard Pedo Series HF-F1S #1 Pedo Forceps HF-F16S #16S Pedo Forceps HF-23S #23S Pedo Cowhorn Forceps HF-F39 #39 Pedo Forceps HF-F40 #40 Pedo Forceps HF-F150XAS #150S Pedo Forceps Upper Split Beaks Serrated HF- F151XAS #151S Pedo Forceps Lower Split Beaks Serrated Presidential Pedo Series HF-F150S HF-F151S

#150S Pedo Forceps Upper #151S Pedo Forceps Lower

Rainbow Presidential Pedo Series HF-F150SR #150SR Pedo Forceps Rainbow Upper HF- 151SR #151SR Pedo Forceps Rainbow Lower Kinder Pedo Series HF-F23K HF-F150K HF-F151K

#23K Pedo Forceps Cowhorn #150K Pedo Forceps Upper #151K Pedo Forceps Lower

INSTRUMENT SOLUTIONS

FAILURE TO REPLACE Who Pays the Ultimate Price?

Breaking It Down: Cost per Use Unfortunately, more often than not, scalers are often looked at as a lifelong part of the furniture when they should be classified as a consumable commodity in practice assets and order budgeting. Every time a scaler is used, the blade dulls and requires maintenance sharpening. Over time, the working end of the scaler will reduce in length and width. Continued usage of a scaler with a reduction greater than 20% in the working end increases the risk of instrument breakage subgingivally as well as decrease adaptability of the blade to the surfaces the instrument is intended for leading to tissue trauma and operator fatigue. Instruments are ergonomically designed to be used in optimal conditions for both patient and clinician’s comfort and safety.

What criteria do you utilize when deciding to replace a scaler? The condition of the working end? Broken blades? Your curettes have become sickles from an incorrect sharpening technique or the knowledge of the physical and often irreversible effects on your body when using a scaler that is past its ‘use by’ date? What about the consequences of using a compromised scaler on a patient? Do these facts affect your decision on when to replace? As an Educator, one of the most frequently asked questions I receive is….’How long does a scaler last before it should be replaced?’ The answer to this question unfortunately lies within the abyss of answers to questions such as “How long is a piece of string?” or “Where did my other sock go that was in the dryer?”. The current recommendation is that when 20% of the instrument blade width or length is reduced or no longer the original design, it is time to replace the instrument. How long it takes for each instrument to reach this threshold is dependent on factors such as: •

• • • • •

Scalers that are sharpened infrequently may have a “longer” lifespan resulting in less frequent replacement and associated costs however, what are the associated cost and risks of a dull, suboptimal scaler? Let’s look at what we already know: An instrument in sub-optimal condition is ineffective and inefficient. The scaler will have reduced tactile sensitivity which can lead to the inability to detect or remove deposits and an increase the likelihood of burnished calculus and slipping while trying to remove it. Increased lateral pressure and number of strokes are required to remove the deposits which affects both the patient’s comfort as well as fatiguing the clinician’s hand, wrist, arm and shoulder. The increased number of strokes required can take more time during the appointment than it would to sharpen the instrument prior to use.

The frequency of use: how many setups of instruments are available and how many times per day each is used, as well as how many days per week are Difficulty of patients (quantity and tenacity of the calculus) Use of ultrasonic devices Frequency of sharpening as well as proficiency of sharpening Use of instruments only for the intended use What material the blades are made from (Immunity Steel Vs Emerging Technology)

Problem: Improper Sharpening Problem: Beyond Life Expectancy

1 3 0 0

6 5

8 8

2 2

7 3

INSTRUMENT SOLUTIONS

In a hypothetical scenario, let’s say a clinician is working 5 full days per week. The scalers are used and processed 3 times per day. At the 12-month instrument check – let’s also factor in 4 weeks holidays per year where the instruments are not being used, the working end has lost 20% of its’ length and/or width. At a price of $80 per instrument, the scaler will cost approximately .13 cents per use. What other consumable commodities do you use in your daily practice that would have an equal value? For example, the average cost of a prophy cup is .65. That’s worth 5 instruments! The Costs for the Clinician A literature review2 conducted by Johnson and Kanji in 2016 states that 92% of Dental Professionals reported symptoms in at least 1 anatomical, upper body region in the past 12 months with Dental Hygienists being the group most affected (see Fig 1). Work related Musculoskeletal Disorders (MSD) in dental hygienists are often blamed on repetitive movements, awkward and static postures, pinch- grasp, forceful exertions, vibration, poor ergonomics, and insufficient breaks amongst other factors. So how does a dull or compromised instrument contribute to a MSD? Dental Hygienists often perform over 30 repetitive strokes per minute, increasing their risk for muscle strain 3.4 Factor in using a small diameter, a heavier weighted handle and/or a dull or sub-optimal blade results in increased pinch-force and lateral pressure required to remove deposits Fig 1

7 4

Fig 2

Fig 3

3,5,6,7. Over time, the repetitive strain and cumulative trauma subsequently cause clinicians to seek out both traditional and complementary treatment modalities to manage pain, reduce their workload or in extreme cases, leave the profession due to MSD’s 8,9. And The Patient As previously mentioned, a dull or compromised scaler can lead to increased discomfort and decreased tactile sensitivity due to increased lateral pressure and number of strokes needed to remove the deposits. The cost of burnishing calculus, resulting in iatrogenic and supervised progression of periodontal disease when patients are placing their oral health in our hands cannot be measured (Fig 3,4). Breakage of a blade in a patient’s mouth, with possible need for surgical intervention due to using an over-worn working end is a preventable situation with a simple and quick check of the working end against a template. What can we do? When having discussions with workshop participants, I have discovered that a large number of practitioners do not routinely sharpen their instruments on a daily basis with the most common reason being that they simply do not have the time. If sharpening is performed routinely, the process should only take a minute or two per kit at each appointment – less time than trying to removed calculus with a dull blade. When performing subgingival debridement, a sharpening stone sterilised with the instrument setup will make it easier to debride as you go. Scalers should be sharpened before every patient for efficient and effective appointments3. Fig 4

INSTRUMENT SOLUTIONS

FAILURE TO REPLACE WHO PAYS THE ULTIMATE PRICE?

To quote Periodontist Dr Victor M Sternberg, ‘Curettes should be replaced regularly and instrument sharpening is not optional to be a successful (clinician)’. Would you use a dull bur to prepare a tooth for a restoration? Choosing appropriate instruments with considerations for the weight and handle design, wider than 11m with either a criss-cross or knurled surface reduces the need for pinch-grip and over exertion 7. A routine, quick assessment of your scalers against a template (Fig 2) is a simple way to ensure neither you nor your patients’ health are being compromised and that you can continue to provide care in a safe and healthy environment. This check can be completed by the clinician or nurse prior to instrument processing. Scalers need to be valued as consumable stock to ensure clinicians feel confident and empowered to maintain them without the pressure to try to make them last longer. Worried about how to dispose of your worn instruments? Hu-Friedy Australia / New Zealand have a recycling initiative conducted when attending relevant dental conferences with details emailed to dental practices prior to the events. Deb is a Dental Hygienist with a Grad Dip in Restorative Dental Hygiene (Canada). She has worked in a variety of health care settings over the past 30 years in both hospital and private practices providing care in general dentistry, periodontics, orthodontics, TMJ and facial pain, cancer care and medically compromised patients. Deb holds a Cert IV TAE and has completed a Graduate Diploma in Clinical Teaching. She has held both Executive and Non-Executive positions in the Victorian branch of

Bibliography 1. Rucker LM, Sunell S. Musculoskeletal health status in BC dentists and dental hygienists: Evaluating the preventive impact of surgical ergonomics training and surgical Vancouver: Workers’ Compensation Board of British Columbia; 2000. pp. 1–91. 2. (PDF) The impact of occupation-related.. Available from: https://www.researchgate.net/publication/317224618_The_ impact_of_occupation-related_musculoskeletal_disorders_on_ dental_hygienists[accessed Jul 19 2018]. 3. Sanders MA, Michalak-Turcotte Strategies to reduce workrelated musculoskeletal disorders in dental hygienists: two case Work-related MSDs and dental hygienists 79 Can J Dent Hyg2016;50(2):72-79 studies. J Hand Ther. 2002;15(4):363–7 4. Branson BG, Black MA, Simmer-Beck M. Changes in posture: A case study of a dental hygienist’s use of magnification loupes. Work. 2010;35(4):467–76 1. Michalak-Turcotte Controlling dental hygiene work-related musculoskeletal disorders: the ergonomic process. J Dent Hyg. 2000;74:41–48 2. Kerschbaum WE, Liskiewicz Cumulative trauma disorders: an ergonomic approach for prevention. J Dent Hyg. 1997;71(4):162– 67 3. Rempel D, Lee DL, Dawson K, Loomer The effects of periodontal curette handle weight and diameter on arm pain A four-month randomized controlled trial. J Am Dent Assoc. 2012 Oct;143(19):1105–13 4. Akesson I, Johnsson B, Rylander L, Moritz U, Skerfving S. Musculoskeletal disorders among female dental personnel — clinical examination and a 5-year follow-up study of Int Arch Occup Environ Health. 1999;72:395–403 5. Crawford L, Gutierrez G, Harber Work environment and occupational health of dental hygienists: A qualitative assessment. J Occup Environ Med.2005;47(6):623–32

the DHAA and has provided training nationally to Oral Health Professionals on smoking cessation. Deb currently works part time in private practice and is an Educational Consultant for both Hu-Friedy and EMS.

h en r y sc h e i n .c o m .a u

DEB BROWN RDH Dental Hygienist Canada

7 5

HANDPIECE SOLUTIONS

DURABILITY AND LONGEVITY BENEFITS OF A 3 GEAR SYSTEM IN A 1:5 SPEED INCREASING CONTRA ANGLE HANDPIECE

The Morita TorqTech 1:5 contra angle red band handpiece has a three gear system plus double internal gears and involute gears that all contribute to super durability. While enhancing both handling and safety, durability is greatly improved by the use of the three-gear system plus double internal gears and involute gears. This enables the handpiece to stand up to repeated autoclaving astonishing well.

Super Durable 3 Gear System With only 2 gears the teeth must be smaller. The three gear system uses bigger gears by employing internal and involute gears that gradually increase the speed. This makes the whole system more durable and less vulnerable to wear. (CA51FO)

Three Gears: Larger teeth carrying the load.

Two Gears: Load is concentrated on smaller teeth.

Internal Gear System for Maximum Activity Space In order to use larger gears within the limited space inside the handpiece, two internal gears are used. These have the teeth on the inside rather than the outside as with conventional gears.

7 6

HANDPIECE SOLUTIONS

Involute Gears These gears contribute greatly to better durability because they move more smoothly against each other, reduce friction and lessen wear.

Involute Gear : Gears that use an involute tooth shape

TorqTech vs a Standard Size Head The smaller head is more comfortable for patients and offers better access in the posterior region. It is especially helpful when the patient has limited opening. A standard sized head is generally taller and strikes opposing teeth in the treatment area. The sensation of this can be stressful and uncomfortable to patients.

Handling Comparison of TorqTech and Morita’s CAI. Dotted Lines and shaded areas show difference in shape.

Safety Morita TorqTech contra angle handpieces hold burs with great security. Morita has invented a unique chuck design that uses three prongs and a three-dimensional spring mechanism so that the chuck is held both vertically and horizontally. The chuck is highly durable and its gripping strength is hardly at all affected by wear and metal fatigue.

Video Watch Morita’s TorqTech Red Band Handpiece Demonstration Video

1 3 0 0

6 5

8 8

2 2

7 7

HANDPIECE & INSTRUMENTS

ERGONOMICS & WELLNESS AT WORK TIPS FOR RELIEVING AND PREVENTING THE ACHES AND PAINS OF WORKING AS A DENTAL HYGIENIST

Does your body hurt more than usual?

Proper Posture and Patient Positioning

Dental hygiene has always been a profession that taxes the mind and the body. But you may be noticing a few more physical aches and pains lately, especially if you are hand scaling—instead of using ultrasonics—to reduce aerosol production.

The less bending, hunching, twisting, craning, leaning, or reaching you do as a hygienist, the less tension you’ll put on your muscles, joints, and bones.

If you’re like most hygienists, it’s not just your hands, wrists, and arms that hurt. Your daily work can also take a toll on your back, neck, shoulders, and legs. Dental hygienists are at risk for conditions such as carpal tunnel syndrome, repetitive motion injuries, and even chronic headaches. This pain can strike at any point during your career: Between 64% and 93% of dental professionals experience general musculoskeletal pain. In fact, musculoskeletal disorders are the leading reason for early retirement among dentists. What Causes Musculoskeletal Pain and How Can You Prevent It? Hygienists tend to repeat the same motions from patient to patient, day in and day out, often in awkward positions. This is a recipe for pain and physical disorders that can derail a career. Here are three ways dental hygienists can avoid pain and repetitive stress injuries: 1. Better positioning (for yourself and your patients) 2. Ergonomic instruments and equipment 3. Simple wellness exercises

7 8

The proper position for working with a patient is seated, with your spine in a neutral position and your shoulders relaxed. Work as close to the patient as possible to avoid overextending your arms or back, and always face the patient. Keep your feet flat on the floor and adjust your stool’s height so your thighs slope slightly downward. Think of yourself as a tripod, with your weight evenly distributed through each foot and your buttocks. If you need a better view of the patient’s oral cavity, ask the patient to turn their head, and use HD mirrors to improve visibility. Keep your instruments at roughly arm’s height and within a 21-inch radius of yourself. The patient’s body position also has a tremendous impact on your ergonomics. According to RDH Magazine, the patient should ideally be positioned supine for treating the upper arch and semi-supine for the lower arch, but this practice is often impractical due to time constraints. Instead, they recommend positioning the back of the patient’s chair at a 10- to 15-degree angle from the floor. Then, use a contoured dental neck cushion to achieve the proper orientation of the occlusal plane. Be sure to ask your patients to scoot to the end of the headrest. This will eliminate the need to reach over the empty space on the headrest.

Ergonomic Scalers and Curettes Designed with TrueFit™ Technology

Ergonomic Instruments and Equipment Ergonomics should be a key consideration when choosing dental instruments and equipment for your practice.

HANDPIECE & INSTRUMENTS

Another important factor in instrument ergonomics is the sharpness of the blade. Sharp scalers require less force to do the same amount of work, which can help both you and your patient be more comfortable. Harmony™ Scalers and Curettes feature EverEdge™ 2.0 Technology. With EverEdge 2.0 Technology, working ends are 72% sharper out-of-thebox than the next leading competitor and remain 50% sharper after 500 strokes.

The Operator Stool From an ergonomic perspective, the operator stool is the most important chair in the treatment room. Proper positioning begins by adjusting the stool first and the patient second.

Wellness Exercises to Relieve and Prevent Pain

Your stool should be adjustable, with adequate lumbar, thoracic, and arm support. It should allow for a space of three fingerwidths behind your knee. If your stool has a tilting feature, tilt the seat forward between 5 and 15 degrees. (If not, use an ergonomic wedge cushion.) Saddle-seat stools may be the ideal option for dental hygienists – especially shorter people. This type of stool maintains your pelvis in a neutral position and allows the optimal curve of your spine. Lighting Another helpful piece of ergonomic equipment is a loupe with a built-in headlight. Loupes provide magnification so you don’t have to bend to see the patient’s oral cavity better. Headlights move with your gaze, eliminating the need (and annoyance) to continually readjust the overhead light. Instrumentation The instruments you choose can also make a significant difference. Look for an instrument with an ideal weight and large diameter that provides a textured grip surface. These instruments will be easier to maneuver and cause less hand fatigue while probing, scaling, and root planing. The science behind ergonomic design matters too. The new Harmony™ Ergonomic Scalers and Curettes are a good example. The result of a cutting-edge iterative research and development process that analyzed over 2.8 million data points, the Harmony™ Scaler reduces pinch force up to 65% and pressure on the tooth by 37%. The handle features a recessed double-helix texture for optimal tactile sensitivity with less tactile fatigue. The silicone grip has been extended 30% to provide a secure and nimble grasp.

Before you undertake any physical activity—from a morning run to a day of treating patients—it’s always a good idea to warm up your joints and muscles. Dental hygiene blogger Whitney DiFoggio (writing as “Teeth Talk Girl”) recommends a set of daily stretches for dental professionals that target the wrists, neck, shoulders, and back. DiFoggio writes that she tries to stretch as often as possible, between appointments and any time there’s a chance to move around. “A great time to stretch is when you’re going in and out of the room to take an FMX,” she says. A regular yoga practice can also help you maintain your fitness for work—and you don’t have to attend in-person classes to reap the benefits. Countless highquality yoga videos are available for free online, such as the popular Yoga With Adrienne series on Amazon Prime. Notably, this series includes a video of yoga tips for the hands. Additionally, the Dental Yogis have written about the role of yoga within dentistry, posing the question “Is Mindfulness the New Secret Weapon in Dentistry?” You’re Not Suffering Alone Keep in mind there’s no shame in feeling pain as a dental hygienist, and you’re far from the only hygienist to experience this. The good news is that a few changes to your routine, posture, instruments, or fitness regimen can do wonders for your body and can potentially add years of injury-free practice to your career.

All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

h en r y sc h e i n .c o m .a u

7 9

EQUIPMENT SOLUTIONS

YOUR PLANT ROOM IS THE HEART OF YOUR DENTAL PRACTICE

Plant room equipment covering compressors and suction units are often the forgotten member of the dental clinic. As such, reliable and high-quality products are pivotal in ensuring ongoing workflow with minimal breakdowns. Critical parameters for an efficient plant room includes: Mechanical Air conditioning is the best way to maintain a stable temperature in the plant room to ensure optimal performance of compressor and suction units. Modern split air conditioning system is very efficient and affordable. Central air vented conditioning systems from surgery is not suitable. Another advantage with a dedicated air conditioner in your plant room, no vents are required, so noise emissions are greatly reduced.

Suction unit installation in cabinetry is unique and not optimal. If a unit cabinet installation is unavoidable, it is imperative to protect the suction unit from overheating caused by insufficient ventilation it is recommended to use the an appropriate ventilation set for cabinet installation. To permit proper air exchange, a controlled air flow behind the cabinet must be ensured so that cool incoming air does not mix with the warm exhaust air.

Fan-forced ventilation systems turn over the air in the plant room. Cool air is drawn in while hot air is exhausted via the in-line fan. With this ventilation method, minimum and recommended fan capacity of 100m3/hr per 1 kW power rating of your equipment.

Yearly maintenance and service is paramount to ensure plant room products are performing to its nominated capacity. In a compressor, each cylinder filter (Sterile filter) must be changed yearly. If fitted, the membrane drier should be serviced yearly.

There are drawbacks with fan-forced ventilation: •

Noise – the vents needed to allow air to flow through the plant room also allow more noise to escape the room, including extra noise generated by the cooling fans

•

Temperature – an efficient fan-forced ventilation system will only reduce the temperature to 10°C above the incoming air temperature. Also, temperature control is only as consistent as the incoming air temperature

Mechanical air-conditioning unit

Fan-forced ventilation

8 0

EQUIPMENT SOLUTIONS

Apart from prescribed daily maintenance of the suction unit, yearly service must include change of inlet filter/s, change of exhaust filter notwithstanding the need to ensure general plumbing attachments are in order and no leaks detected. The annual service is often necessary to comply with and maintain manufacturer’s warranty.

Typically foam-free liquid concentrate for the simultaneous disinfection, cleaning, deodorisation and care of all suction units and amalgam separators must be selected. When researching for your preferred suction line cleaner it is worth considering its capacity and whether the following specifications are met:

Quality of air in the plant room is today more important than ever before. Often, both compressor and suction units are installed in the same room. To ensure no pathogenic loaded air is circulated from suction unit to the inlet of the compressor, a certified HEPA filter should be fitted and preferably vented to the outside of the plant room.

•

Bactericidal, yeasticidal, limited virucidal and non-enveloped viruses (Adeno, Noro)

•

Dissolves and disinfects biofilm and prevents the formation of sludge (blood and proteins)

•

The solution for contaminated suction units provides safe protection against infection

Suction line maintenance is critical for all you suction units and lines. Most units are disinfected as prescribed, but not all are correctly cleaned. Over a period, dental materials, fillings and filling agents or powders used in prophylaxis treatments build up to form a thick sludge. This leads to blockages, which in turn leads to a loss of performance and, in the worst case, can lead to a complete shutdown within the surgery.

•

Tested material quality – recommended by leading unit manufacturers

1 3 0 0

To prevent possible shutdowns, it is critical daily/weekly disinfection procedures are followed based on the manufacturer guidelines.

6 5

8 8

2 2

8 1

EQUIPMENT SOLUTIONS

EQUIPMENT IS IN OUR DNA

At Henry Schein, equipment is in our DNA, we have an enviable selection of capital equipment from four of the world’s leading manufacturers being A-dec, KaVo, Morita and Planmeca. This range enables us to be flexible in meeting your needs. For example, if you’re looking to have a suite of equipment, all from the one ecosystem, Planmeca is a great choice; offering innovative Compact I Chairs, Intra Oral and Extra Oral video imaging, ProMax 2D and 3D X-ray, Emerald S CAD CAM mills and printers. This system is grounded by Planmeca’s fully integrated and powerful Romexis 6 software. We also offer premium Japanese quality and reliability, with Morita. Their equipment looks and feels bespoke in a mass-produced world. On closer look you’ll find Morita are the quiet achievers, their endodontic systems appear on other leading brands, and their imaging with the X800 is unparalleled in its quality. Definitely add Morita to your list if you’re seeking a suite of equipment that has that tangible feel of quality. KaVo offers the traditional German solid build so often missing from modern chairs, manufacturing from Biberach Germany for chairs and handpieces. KaVo’s 100 years of production heritage is evident, from affordable workhorses to the premium. If you have barely a moment in your day, KaVo’s sound and proven ergonomics and features may well be the answer to improving your dental chair productivity; less fiddling, more work.

8 2

Our most recent edition is A-dec, renowned for reliable and straight forward solutions for the busy practice, A-dec is the undisputed champion of the American dental manufacturing industry. With A-dec we can adapt elegant solutions to your specific equipment requirements. In selecting Henry Schein, our relationship with your practice is underpinned as Australia’s largest dental supplier. Our goal is to be your trusted partner providing a one stop shop for all your dental needs no matter the size or focus of your practice. Our equipment support consists of a dedicated equipment team of over 70 people from warehouse through sales and on tools service support. If your practice is some distance from our offices, we also support those smaller regional businesses, which support you. Metro or country, we’ll have a support close to hand. When visiting our sales team, you’ll find our approach quite different; it starts with the question; “How can we help you?” We then pause and listen. With our range and your preferences, we tailor the solution to your need, quite a different approach to the single brand push. It allows us flexibility to offer tight brand integration or create a strongly connected hybrid package that really fits and optimises your working style.

EQUIPMENT SOLUTIONS

Our showrooms are like mini exhibitions, multiple brands and choices side by side. Consumables or Imaging, Dental Chairs or CAD CAM, Practice Management or Inventory Solutions, our offices are a great place to compare and a hub of experts that are conveniently there to assist you. We’re also always looking at the big picture, how we can best support the entire practice – bundling solutions is our forte, and we encourage you to take advantage of this service.

You’re invited to make an appointment or pursue a confidential practice planning session. All you need to do is reach out to your local Henry Schein Rep or call on 02 9697 6291, alternatively email us at equipment@henryschein.com.au and simply tell us, how we can help you today.

h en r y sc h e i n .c o m .a u

8 3

EQUIPMENT SOLUTIONS

CASE REPORT GUIDED IMPLANT SURGERY WITH PLANMECA ALL-IN-ONE SOLUTION

Last spring, Dr Seppo Lindroos was approached by a young female patient with several congenitally missing teeth and a weakened bite. To prevent further issues the missing teeth might cause for the patient, Lindroos decided to perform guided implant surgery at his Medident Dental Clinic in Finland. The following case report illustrates how seamlessly Planmeca solutions can be used for each step of the treatment and treatment planning. Dr Seppo Lindroos is a specialist in aesthetic dentistry and implantology. Last spring, he was contacted by a patient who was having issues with her bite due to several missing teeth. The patient, a female in her twenties, had congenitally missing permanent mandibular second premolars and second molars. She had lost her persistent primary second molar a couple of years earlier and was now experiencing problems with her weakened bite. A panoramic X-ray image was captured with Planmeca Promax® 2D imaging unit to get more information about the dentition. Treatment possibilities were discussed with the patient. As the patient was already old enough for an implantation, it was decided to place an implant to replace the mandibular second premolar to prevent further damages the missing tooth might cause for her dentition. For the implant treatment planning, a CBCT image was first captured using Planmeca Viso® G7 X-ray unit and the teeth were scanned with Planmeca Emerald™ intraoral scanner. The CBCT image and the intraoral scan were combined in Planmeca Romexis® software for the treatment planning. The implant planning was carried out in Planmeca Romexis® 3D Implant module, which includes an implant library with implant models from over 100 manufacturers. A CONELOG® SCREW-LINE implant by CAMLOG® with a 4,3 mm diameter and 9,0 mm length was chosen for the patient, and its placement was then carefully planned with the software’s implant-centric viewing mode.

8 4

To achieve the planned implant position, Dr Lindroos decided to use a surgical guide for the implant placement. According to Lindroos, he prefers guided surgery in most of his implant cases to ensure the implant is placed in an optimal position and because it reduces operation time as well as the patient’s recovery time. For this treatment, the guide was designed with Planmeca Romexis® 3D Implant Guide module. The guide was then 3D printed by Planmeca ProModel™ service, which offers patient-specific implants and surgical guides as a service for demanding surgical procedures and treatment planning. After the implant was placed using the surgical guide, a temporary healing abutment was placed on the implant site to help gum tissue heal before the restoration could be planted. After the healing period of three months, a scan abutment was placed on the implant. The teeth were scanned again with Planmeca Emerald intraoral scanner for the restoration design. The intraoral scans were sent to a partner laboratory for the final restoration design using the cloud-based image transfer service Planmeca Romexis® Cloud. As the service is an integrated part of Romexis, the laboratory was able to seamlessly quick launch the case files in Planmeca PlanCAD® Premium software module, which was used to design the abutment and the crown with screw channels. The restorations were then milled in the laboratory with Planmeca PlanMill® 50 S milling unit.

EQUIPMENT SOLUTIONS

The final abutment was manufactured using a prefabricated titanium abutment block and IPS e.max CAD was used for the crown on top of the abutment. Those were post-processed, characterised and then bonded together in the laboratory to create a screw-retained restoration.

The digital implant workflow offers numerous advantages for the patients as well, as it speeds up the complete treatment process, including the surgery itself. At the same time, the treatment is more predictable and convenient for the patient. Intraoral scanning, for example, is more comfortable for the patient than traditional impressions, and the recovery from guided surgery is easier and faster.

Finally, the screw-retained restoration was placed on the implant. The laboratory-milled crown based on the intraoral scan was a perfect fit and did not need any changes on the approximal surfaces. When the restoration was placed, Lindroos made only a minor change to the bite.

As the patients are more involved in the treatment planning and can see the predicted outcome in Romexis beforehand, they have more confidence for the actual treatment and the dentist. This can be especially beneficial if the patient fears dental treatments. In this particular case, the patient herself was also very happy with how the treatment was performed and how well the final restoration sits in her mouth.

“Overall, the Planmeca digital concept made the treatment more precise and faster. Combining different kind of patient data together in Romexis for the treatment planning is simple and straightforward. It is also easy to collaborate with external partners due to the open architecture of the software,” Lindroos comments.

1 3 0 0

6 5

8 8

2 2

8 5

DIGITAL SOLUTIONS

NIRI AS A DIAGNOSTIC AID

NIRI is a diagnostic aid for interproximal caries detection above the gingiva without the need for radiation

Interproximal carious lesions are clinically apparent as a chalky white discolouration.

NIRI - A REFLECTIVE CONCEPT OF LIGHT & ITS MECHANISM OF ACTION

It is estimated that it takes about 4 years for an inital proximal lesion to be seen clinically1. Effective diagnosis of interproximal carious lesions is affected by the natural anatomy of the tooth, alignment within the arch and technique sensitivity involved with radiographs. Hence, using effective tools that aid in confirming the presence of a lesion at it’s earliest stage can prove to be a major advantage while treating patients. Elsevier Textbook of Oral Medicine Oral diagnosis and Oral radiology edition 2 Editiors Ravikiran Ongole BDS,MDS,Praveen BN, BDS,MD 1

The iTero Element 5D intraoral scanner uses light of 850nm that penetrates into the tooth structure to produce a NIRI image.

NIRI image of a healthy tooth

IMAGE INTERPRETATION - HEALTHY TOOTH

Enamel is mostly transparent to NIRI and appears dark Dentin is mostly scattering to NIRI and appears bright

IMAGE INTERPRETATION - TOOTH WITH CARIES Healthy enamel appears dark

Proximal carious lesions of the enamel appear bright

8 6

DIGITAL SOLUTIONS

CROWN-LAY LITHIUM DISILICATE RESTORATION

The new 3Shape Dental System 2020 denture software delivers excellent accuracy and esthetics on full and partial denture production, with up to 20% COST-SAVINGS1 compared to conventional denture workflows. Explore more at www.3shape.com/indications/dentures

1 “Having done close to 1,000 digital dentures, our costs are down 20% and the quality is much higher.” Germen Versteeg, Denturist and Founder, DTL Mediaan, Holland.

Contact your reseller regarding availability of 3Shape products in your region. © 3Shape A/S, 2020. The 3Shape name and logo and/or other trademarks mentioned herein are trademarks of 3Shape A/S, registered in US and other countries. All rights reserved.

Case information A male, age forty-three is a long-standing patient at the practice. He has full dentition with several crowns present on molar teeth. There is a history of bruxism, clenching and cracking teeth with the patient not a very compliant occlusal splint wearer. Tender tooth 46 has a deteriorating large MOD composite resin filling with a lingual crack visible under high magnification. Tooth tests positive for a crack associated with the ML cusp. The patient was given two options for treatment: • Replace filling with a larger resin filling that eliminates the ML crack • Remove resin filling and undermined cusp and restore with a porcelain crown/onlay Upon assessment of the clinical presentation, functional habits, patient history, treatment plan and intended outcome, a decision was made for a crownlay preparation and fabrication of lithium disilicate restoration.

Fig. 1i

Fig. 1ii

Treatment goal The treatment goal was to create an aesthetic crown that met all clinical requirements and accommodated the patient’s parafunction and intermittent occlusal splint usage. Treatment Time spent on each procedure throughout the case is documented by Dr. Somana. Lower full arch and model set pre-prep 3Shape TRIOS IO scan (7 minutes) Fig. 1 (i + ii), 2

Fig. 2

DR. KASEN SOMANA Tooth prep under 12x magnification (30-40 minutes) - Fig. 3, 4, 5

h en r y sc h e i n .c o m .a u

Fig. 3

8 7

DIGITAL SOLUTIONS

Fig. 4

Fig. 5

Prep-Arch Scan (30 seconds)

Fig. 6

Occlusal plane defined

Fig. 7

Restorative anatomy design proposed by TRIOS Design Studio

Fig. 8

Restorative anatomy design proposed by TRIOS Design Studio

Fig. 9

Restoration’s occlusal fit checked with 3Shape Patient Specific Motion and adjusted Fig. 10, 11

Fig. 10

Fig. 11

Fig. 3

Final restoration

8 8

Fig. 12

Occlusion checked in virtual articulator

Fig. 13

DIGITAL SOLUTIONS

Original tooth used as a guide to design the crown to minimal thickness stipulated by Fig. 14 the material of choice and to aid in matching the existing occlusal splint. Fig. 14, 15

Fig. 15

Restoration placed in CAD block for milling Fig. 16, 17

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Remarks from Dr. Somana

The clinical benefits of TRIOS Design Studio

Using TRIOS Design Studio, the designed crown inserted with no occlusal adjust post cementation. The entire procedure was completed within a total of 75 clinical minutes. A decision, however, was made to complete this case over 2 appointments. This was due to limited clinical time available on the preparation day and time not being critical to the patient. During treatment, the biggest challenge for us was to create an aesthetic crown that met all the clinical requirements and, that would accommodate the patient’s parafunction and intermittent occlusal splint usage. For us, the ability to use the original tooth as a guide for designing the crown to minimal thickness stipulated by the material of choice and to aid in matching the existing occlusal splint was invaluable. This function along with the ability to record a patient’s specific motion in TRIOS Design Studio significantly improves crown design from a functional and an aesthetic/anatomic perspective. These combined functions allow for a more predictable outcome.

•

1 3 0 0

• • • • • • •

Fast and accurate scans from the 3Shape TRIOS intraoral scanner Simplicity and efficiency of crown design Excellent marginal fit and therefore seal Zero occlusal adjustment required post bonding of the crown Minimal adjustment to existing occlusal splint The ability to design the crown by using the original tooth as a guide in the pre-preparation scan The ability to design, adjust, and adapt the crown to the patient’s own specific excursive movement OR with a traditional semi adjustable virtual articulator Absolute confidence in the quality of the restoration produced with the TRIOS Design Studio workflow

Benefits of the digital chairside workflow for my patients according to Dr. Somana • Simplified workflow • Far more comfortable experience • Turnaround times that is suitable to the patient and clinician’s requirements • Excellent results

6 5

8 8

2 2

8 9

CAD / CAM SOLUTIONS

THE INLAY WITH THE CHAMELEON EFFECT SUPER TRANSLUCENT VITA ENAMIC ST

If you are looking for the perfect inlay material for your daily practice, look no further than VITA ENAMIC ST. The super translucent CAD/CAM block for efficient chairside treatment is based on the clinically proven hybrid ceramic blueprint, which has been in use since 2013. Under pressure and heat, a porous pre-sintered fine structure feldspar ceramic block (86 % by weight) is infiltrated with a polymer (14 % by weight). The dual network also offers clear advantages with regard to inlay treatment: the minimum layer thickness in the isthmus range is only one millimeter, which allows for a minimally invasive and defect-oriented preparation. The precise edges and the excellent edge stability offer a perfect fit. Firing is not required. After grinding, the restoration is finished and polished, then ready for integration. If desired, the light-curing stains from the VITA ENAMIC STAINS kit can also be used for individualization and glazing. VITA ENAMIC ST hybrid ceramic – everything else is just composite Due to the dominant ceramic network, the material can be etched and silanized in the usual way with hydrofluoric acid. This not only leads to best adhesion values when fully adhesive bonding is used, but also saves the need to purchase a sand blasting unit, which is required with CAD/CAM composite blocks, which are often incorrectly referred to as hybrid ceramics as well. Unlike in VITA ENAMIC, a dual network material is not possible with composites, where, glass or ceramic fillers are embedded in a typical polymer matrix. VITA ENAMIC ST is suitable for all restorations surrounded by enamel: inlays, onlays and table tops.

9 0

In this case history documentation, Prof. Dr. Alexander Hassel (Mannheim, Germany) describes an easy and efficient way to fabricate a VITA ENAMIC ST restoration, and demonstrates how the highly translucent restoration with the chameleon effect merges optically and functionally with the residual substance of the tooth. VITA VITA’s areas of expertise include ceramic implants, denture teeth and veneering materials, CAD/CAM blanks and press ceramics, furnaces and dental materials – all VITA product solutions are developed to be part of a complete system that offers efficient overall processes. In dentistry, VITA remains the pioneer in tooth shade determination. Worldwide, four out of five shade values are determined with the VITA shade standard. VITA tools for analog and digital shade determination, communication and checking (e.g. VITA Easyshade V) ensure perfect shade matching. Laboratories and dental practices in over 125 countries receive additional practical support and advice for their daily work through VITA’s international course program.

CAD / CAM SOLUTIONS

Fig. 2: Defect-oriented preparations after excavation of cavities and adhesive filling.

Fig. 3: Due to the dominant feldspar ceramic network, VITA ENAMIC ST can be etched with hydrofluoric acid.`

Fig. 8

Fig. 4: Afterwards, the milky, etched surface can be silanized for an optimal chemical bond.

Fig. 5: An air block prevents the formation of an oxygen inhibition layer during light curing.

Fig. 6: The fully adhesive restorations merge functionally and esthetically with the residual tooth substance.`

Fig. 7: The chameleon effect of super-translucent hybrid ceramics also ensures restorations are invisible from the vestibular view.

PROF. DR. ALEXANDER HASSEL Mannheim, Germany

h en r y sc h e i n .c o m .a u

9 1

3D PRINTING SOLUTIONS

IMPLANT & RESTORATIVE DENTISTRY A NOVEL APPROACH USING OPTIMIZED SCAN STRATEGIES & 3D PRINTING ®

Introduction

Treatment planning protocols

The evolution of digital technologies in dentistry has paved the way for the development of simplified and predictable protocols in restorative dentistry.

Whether using an analogue or a digital workflow, proper treatment planning protocols are the foundation of any fixed restorations in the arch involving dental3D implants. printing reimagined

This article supplemented with a case study, illustrates the many aspects where digital dental technologies, from intra-oral scanning, implant treatment planning and 3D printing, has allowed the seamless delivery of treatment that traditionally has been regarded as difficult and complex.

These generally include:

Why choose a digital workflow? Conventional analogue techniques are associated with certain disadvantages, such as patient discomfort during the impression taking; the potential for distortion of the impression material and delays in transfer time between the surgery and the lab. Taking a digital impression with an intraoral scanner such as the Trios (3Shape) bypasses these disadvantages. Combining a digital impression and CAD software simplify workflows such as diagnostic facially-driven mock-ups, implant treatment planning and the design and fabrication of surgical guides. CAD software allows for the design of the master die model, as well as the temporary and definitive restorations, which can then be manufactured either with a 3D printer or milling machine. The data from the digital impression is also simply sent over the Internet, significantly reducing the time needed to manufacture the wax-ups and prosthesis.

9 2

PRO 4K

•

Articulated study models from diagnostic impressions

•

Diagnostic wax-up / intraoral wax-up / diagnostic appliance to evaluate aesthetics and phonetics

•

Radiographs (including periapical x-rays and

•

CBCT scans) to evaluate bone support

•

Radiographic and surgical guide fabrication.

Digital implant planning In implantology, the full digital workflow simplifies accurate diagnosis and implant position planning using the intraoral scan and CBCT data. This allows for the fabrication of a surgical implant guide to facilitate implant placement (guided surger y), creating a simplified, accurate and predictable protocol. This provides better angulation and accuracy of placement for both single and multiple implants. The CAD design of the restoration can be planned, visualized and even designed prior to the patient even attending for the surgical phase of treatment. Furthermore, the number of patient visits required for the procedure is reduced.

4K MODE

www.asiga.co

3D PRINTING SOLUTIONS

Case report

Pre-operative OPG

The following case study demonstrates a scenario where a complete digital workflow was utilized in the treatment planning, design, implant placement and natural tooth restorations to rehabilitate the full upper arch. In this first part of three articles on this case, I will demonstrate the digital workflow for treatment planning, implant placement and the fabrication of the first provisional restoration. A 79-year old patient presented with the complaint of mobile teeth and occasional discomfort from the areas around his existing upper fixed partial denture (figs. 1 to 3).

Pre-operative occlusal and lateral occlusion

Clinical and radiographic examination revealed bone loss affecting his upper and lower dentition. Secondary decay was also diagnosed on the abutments of his fixed dental prosthesis. The patient’s health history was unremarkable. Periodontal treatment, including the extraction of the periodontally hopeless 16 and 28, was undertaken, and a restorative treatment plan formulated. The remainder of this article can be viewed on Dental Education Hub

Radiographic scatter can lead to the inability to mesh the IOS surface scan to CBCT DICOM data

Radiographic reference markers are placed in the mouth. They are recorded in both the IOS scan and the CBCT scan

DR. ANDREW CHIO BDSc. (Melb)

DR ANTHONY MAK Dentist BDS, Grad Dip Clin Dent (Oral Implants) (USyd)

1 3 0 0

6 5

8 8

2 2

9 3

PRACTICE MANAGEMENT SOLUTIONS

HOW WELL DO YOU REALLY KNOW YOUR PRACTICE PERFORMANCE?

One of the biggest roadblocks facing dental practices is to accurately understand how their practice is performing. Without reliable information on how your practice is performing, how can you begin to understand your threats and opportunities, or develop effective plans to achieve them? Given the lack of business management courses in a typical Bachelor of Dental Surgery degree, it’s

hardly surprising that most dentists admit to wishing they knew more about how their practices are performing. What is surprising is just how bad so many practice management software systems are at providing clear, useful reports.

Without data you’re just another opinion It’s important for practices to understand how they are performing across multiple key metrics and benchmark their performance against industry averages and top performing clinics. Key metrics you’ll want to measure include: • Practice revenue, • Average hourly earnings, • Patient recall effectiveness, • New patients, • Treatment acceptance rates, • Fail-to-attend rates, and • Chair-time utilisation

Taking the right action Once you understand how your practice is performing, it’s important to take corrective action. For example, low new patient numbers each month means that you’ll probably want to review and update your new patient acquisition strategy.

Alternatively, a high fail-to-attend rate may be a sign of a poor appointment reminder system or process. Moreover, taking the right action relies on getting the right advice so that you don’t risk making matters even worse.

If you need help with reviewing your practice performance, simply contact Henry Schein One today for a complimentary business review or health check on 1300 889 668 or visit henryscheinone.com.au/businessreview.

9 4

NEW PRODUCTS SEE THE LATEST INNOVATIONS FROM OUR LEADING GLOBAL SUPPLY PARTNERS

h en r y sc h e i n .c o m .a u

9 5

NEW PRODUCTS

MAXI-GARD PHOSPHOR PLATE BARRIER ENVELOPES

•

A range of single use barrier envelopes for popular PSP machines

•

Design allows quick plate loading and removal

•

Value for money, quality at a reasonable price

•

Available in Sizes 0, 1 and 2.

•

ARTG # 351625

Maxi-Gard VL Phosphor Plate Barrier

Maxi-Gard HL Phosphor Plate Barrier

Maxi-Gard MC Phosphor Plate Barrier

For PSP machines

That accept plate vertically

That accept plate horizontally

PSP plated with magnets Comes with cardboard inserts to protect plates.

Butterfly seam on

Short side

Long side

Short side

Material

Semitranslucent on one side

Black-on-black material

Semitranslucent on one side

Packaging

Size 0 & 1: Box of 100 Size 2: Box of 300

Size 0, 1 & 2: Box of 200

Product Codes

HS-5701558 VL Size 0 HS-5701559 VL Size 1 HS-5701560 VL Size 2

HS-5701561 HL Size 0 HS-5701563 HL Size 1 HS-5701564 HL Size 2

HS-5701565 MC Size 0 HS-5701566 MC Size 1 HS-5701567 MC Size 2

Product Name

Image Sample

9 6

NEW PRODUCTS

G2-BOND UNIVERSAL

Leading the way to a new standard With over 1 billion composite restorations and a century of competence in dental materials,GC is leading the way to new standards in adhesive dentistry. With its proprietary Dual-H-Technology, an advanced optimisation of the bonding to the tooth and the composite, G2-BOND Universal is an all-round universal 2-bottle system combining what clinicians would expect from existing self-etch (SE) and etch-and-rinse (ER) Gold standards, and even more.

Pics courtesy of Dr Jean Meyer, France

IDS Technique

Etching the tooth structure

Application of 1-PRIMER

Application of 2-BOND

After photopolymerisation, the sealed dentin is ready for digital impression

Application of 1-PRIMER

Application of 2-BOND

After photopolymerisation, the restorative material is applied

Pics courtesy of Dr David Gerdolle, Switzerland

Class II restoration

Selective enamel etching

1 3 0 0

6 5

8 8

2 2

9 7

NEW PRODUCTS

G-CEM ONE - SIMPLY THE ONE SELF ADHESIVE RESIN CEMENT

G-CEM ONE is a truly universal, non-technique sensitive cement with high bond strength and excellent self-curing ability. It simplifies all your cementation procedures and gives you more predictable results and peace of mind. G-CEM ONE can be used for a wide range of indications, including challenging clinical situations thanks to the GC Touch Cure.

Images courtesy of Dr Kazunori Otani, Japan

One for all clinical case scenarios Posterior Crown (Zirconia)

Restoration cemented

Final result

Application of Adhesive Enhancing Primer

Final result

Prepared tooth cleaned and dried

Images courtesy of Dr Kazunori Otani, Japan

Anterior Crown (Lithium Disilicate)

Prepared tooth cleaned and dried

Images courtesy of Dr Riccardo Tempesta, Italy

Posterior Onlay (Lithium Disilicate)

Initial situation

Restoration cemented with Adhesive Enhancing Primer

With optional Adhesive Enhancing Primer

9 8

Final result

COMING SOON

G-CEM VENEER LIGHT CURED RESIN CEMENT

An aesthetic cement with simple application and mechanical properties. G-CEM Veneer has all the ingredients to ensure the most stunning end result for a confident smile. The secret is in its optimally balanced formula with Full-coverage Silane Coating (FSC) technology. This innovative filler treatment allows a high filler rate to be achieved with homogeneous repartition of fillers in the matrix. The result: unique handling and excellent physical properties.

0. Before

1. Restoration try-in

2. Preparation etching

3. Apply G-Premio BOND

Four aesthetic shades

Predictable end result

Choose your etching mode

Bonding to all substrates

G-CEM Veneer comes in four different shades. They were carefully selected to cover all aesthetic needs.

With G-CEM Try-in Paste you can easily predict your end result. It helps in selecting the correct shade and opacity

Etch the enamel margins or use a total etch approach for minimal preparations that are localised mainly in the enamel.

G-Premio BOND’s proven formula ensures bonding to all substrates. It is separately cured and so thin that it does not interfere with the seating of the restoration.

4. Apply G-Multi PRIMER

5. Cementation

6. Excess removal

Bonding to all restorations

Precise application

Easy clean-up

After correct pretreatment (etching or sandblasting), G-Multi PRIMER ensures stable adhesion to all aesthetic restoratives.

The thixotropy and long working time allow precise application

Tack-curing for 1-2 seconds before removal is optional. After the final light curing, margins can be easily finished and polished to high gloss to minimize plaque retention

h en r y sc h e i n .c o m .a u

7. Final

Images courtesy of Dr. J Tapia Guadix, Spain.

High Aesthetic Demand with Ease of Placement

Durable outcome The high colour stability and excellent mechanical properties ensure a durable and qualitative end result.

9 9

1300 65 88 22 henryschein.com.au