D E N TA L S O L U T I O N S
AUG / SEPT 2022
CONTENTS - CLICK CATEGORY TO VIEW NEW PRODUCTS
SURGERY SETUP
COSMETIC & RESTORATIVE
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DENTAL EDUCATION HUB
ORTHODONTICS 14
12
16
PREVENTATIVE
PAIN CONTROL
34
ENDODONTICS 48
38
PROSTHETICS
SURGICAL 58
54
INSTRUMENTS 59
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INFECTION CONTROL
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This Edition of Dental Solutions marks a key milestone for Henry Schein, with the 13th September 2022 being the 90 year anniversary of Henry Schein opening his first pharmacy in Queens, New York. To celebrate this landmark event, Henry Schein’s President and CEO Stanly Bergman will ring the bell to open the New York Stock Exchange on the morning of the 13th September. If you would like to find out more about Henry Schein’s 90 year history and timeline, to know CLICK HERE more
DENTAL EDUCATION HUB In Australia, August also marks the 2 year anniversary of the launch of Dental Education Hub. Since its online launch in mid 2020, DentalEducationHub.com. au has quickly become a go to resource for clinicians and dental professionals across Australia, nearing 100,000 onsite visits since launch and almost 20,000 hours of digital training completed, most of which is completely free. To mark the occasion, during the month of August we will be running 13 new webinars, so if you haven’t had chance to take advantage of the platform, then check out the upcoming webinars on page 10-11 or head to the website to start exploring today.
BUSINESS BOOSTER SERIES For most Businesses the post EOFY period marks a good time to reflect on the year so far and plan for the new financial year ahead. Whilst this publication highlights key case studies, workflows and industry leading products you can utilise in your practice, Henry Schein also acknowledges there are many new challenges practices are experiencing in 2022 from inflationary pressures to the ongoing COVID-19 and Flu outbreaks causing staff shortages and impacting patient attendance.To help support you, over the next 2 months Henry Schein and Dental Education Hub is partnering with industry leading solution providers to bring you our Business Booster program, which includes a series of live webinars, articles and discounts to address many of the challenges practices are experiencing today. From patient communication and marketing to managing staffing challenges and boosting case acceptance, the Business Booster Series in conjunction with Henry Schein’s business solutions partners is here to help your practice thrive and grow.
DID YOU KNOW? THE AVERAGE AUSTRALIAN WILL SPEND MORE THAN 75 DAYS BRUSHING THEIR TEETH OVER THEIR LIFETIME.
CALUM COOGAN Marketing Communications Digital & CX Manager
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BUSINESS BOOSTER
BUSINESS BOOSTER LIVE WEBINARS, ARTICLES & DISCOUNTS TO HELP YOUR PRACTICE
Henry Schein360 is partnering with industry leading solution providers to bring you our business booster series. Over the next few months we will have a series of live webinars, articles and discounts to help your practice and address many of the challenges practices across Australia are facing today. From patient communication and marketing, to managing staffing challenges and boosting case acceptance, the Business Booster series and our business solutions partners are here to help your practice thrive and growchallenges and boosting case acceptance, the Business Booster series and our business solutions partners are here to help your practice thrive and grow
DENTAL WALLET
Dream big and accelerate your rewards points with Dental Wallet Are you dreaming of your next big holiday to visit loved ones? Or do you simply want to escape from dental practice life and fly business class to your favourite destination?
Pay bills. Earn points. Access rewards. With Dental Wallet, you can earn up to 3 points per dollar and use your points like cash...
With COVID-19 restrictions easing, travelling abroad for a holiday is at the top of the agenda for many Australians. Pay bills. Earn points. Access rewards. Transfer to fly With Dental Wallet, proudly supported by Henry Schein, you can earn points and convert them to Frequent Flyer points with selected airlines to cover the cost of your next holiday or use towards upgrading your flights. What’s more, if travelling abroad isn’t at the top of your bucket list, Dental Wallet points can be redeemed for rewards with leading brands. Dental Wallet gets even better as points can also be used to pay future business and personal household bills.
How do I sign up to Dental Wallet? Registering for your free Dental Wallet account takes less than a minute. 1.
Register online at www.dentalwallet.com.au
2.
Add your preferred payment method to your Dental Wallet
3.
Pay any bills quickly and securely through your Dental Wallet (program and payment fees may apply)
4.
Earn and redeem your points
Register for free at www.dentalwallet.com.au
Reach your points and rewards goals sooner Click here for more information on Dental Wallet, or click here to register for free.
What bills can be paid with Dental Wallet points?
For existing Dental Wallet users, click here to log in and start paying your bills.
Some examples of bills that can be paid through Dental Wallet that will earn points, include:
Start dreaming big and reach your points and rewards goals sooner with Dental Wallet!
• Business expenses, such as new equipment and consumables 2022
AUG • Charges from Government agencies, such as your tax bill and council rates
ER • Utilities, such S T as water, electricity and internet O O and tuition, such as private school •BEducation S S fees and further training course fees INE S BU
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Business Booster At Henry Schein we remain committed to our mission to improve the lives of all Australians by focusing on practice care, so dental professionals like yourself can focus on patient care. As you are aware we do this by supplying industry leading dental products, through our passionate and knowledgeable team of Relationship Managers, Specialists and Customer Care Agents, but also by providing innovative software and business solutions to help your practice.
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For many, we expected to be getting back to normal in 2022 and hoping we could put the disruption of the past 2 years behind us. Instead as leaders and business owners, we are presented with a whole array of new challenges from recruitment and staffing shortages to patients failing to attend or from case acceptance to managing costs and minimizing financial risk.
BUSINESS BOOSTER
THRIVE AND GROW
To help support your practice, we have partnered with a number of industry leading business solution providers to bring you our Business Booster program, aimed at helping you navigate through the recovery and open doors to new opportunities for your practice.
HUMM
Bite sized payments making patients & practices smile Flex to meet a changing financial climate.
Make your practice humm
The economic climate is changing, and the demand for flexible payment options is increasing as customers deal with higher energy costs, mounting interest rates and rising inflation. The list of increasing expenses is long, and the job market will take time to adjust to salaries that keep up with the climate. Life is expensive.
In the dental industry, instalment provider humm already supports more than 2,000 practices across Australia and New Zealand, providing instalment plans for patient treatment of up to $30,000.
More and more Australians are choosing products and services that offer manageable instalment options. ‘Buy Now Pay Later’(BNPL) as a payment option grew to prominence around 2015, but only in the past 12 to 18 months are we starting to see its potential within essential services, such as dental treatments.
The Business Booster program was created to give you a snapshot of some of the advice, tools and services that are out there to support your business.
The question of cost. The majority of people are conflict averse, and the discussion of money, payment or finances evokes anxiety in a customer. The pressure on a patient to make a snap decision on a pricey procedure is immense, and depending on their financial position, providing the facility for a patient to break down their treatments into manageable chunks puts an affordable lens on a tricky conversation. Patients who may have avoided the dentist altogether may be more likely to seek treatment because of the affordable payment options available, and those who may delay treatment might be swayed the other way. Over 40% of the reasons why people avoid the dentist involve cost. Every practice should have available a solution for patients to be able to afford dentistry and find a way to implement transparency for the patient.
There is a 26% lift in recall when humm is integrated into a quote, practices saw 94% of patient applications approved on the spot, and an ATV of $4,398.
An increase in Average Treatment Value (ATV)
Over a 12-month period they approved over 25,000 dental transactions with a total value of over $100m. That’s $100m in the practices’ bank accounts.
With flexible finance options the question of affordability gets tucked away, and patients now may look to maximise their treatment potential, as the payments will be spread manageably over time. This may mean a lower cost but more drastic treatment like an extraction, could be upgraded to a root canal and a crown, keeping the patient’s smile and bank balance intact. As dental service providers, you will be able to confidently bring all available treatment options to the patient’s attention and recommend the most suitable course of action which, all combined, makes for a better patient experience. Crush cash flow issues and drive debt down Pressure on practices to manage debt, balance books and maintain profitability has traditionally been exacerbated by patients who could not afford the full payment on the day of treatment. An instalment product like humm affords the dentist and patient alike freedom to talk about the clinical merits of the treatments without the stigma or stress of the money conversation. All the debt is carried by the instalment provider and managed by them through the life of the transaction. That means the dental practice gets paid immediately. Money in the practice now, can mean more staff, latest dental equipment, and more business growth sooner.
EXPERIEN INSURANCE SERVICES he nr y s c he i n. c om . a u
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The changing insurance landscape for dentists and options available
The program includes an 8 part series of live webinars held throughout August and September, culminating in a live online panel discussion with our experts where you can grill them with direct questions about their field of expertise.
Experien Insurance Services (Experien) helps thousands of dentists to arrange life and disability insurance, professional indemnity insurance and business insurance. These are complex categories of insurance where they have helped their clients to get claims paid from a wide range of insurers amounting to over $100m. In an environment of low (but rising) interest rates and rising inflation, Experien discuss trends in these classes of insurance and options available. Life and disability insurance Income Protection Insurance is a category of disability insurance and it’s very commonly held by Dentists. We have helped many dentists to claim on such policies for reasons such as cancer, injury, heart attacks, mental illnesses and more. And we have seen how important they have been to those who have claimed. Unfortunately claims have risen significantly over time for many reasons such as a rise in mental illness related claims. This, plus low interest rates (which negatively affect insurers) has led to significant price increases on existing and new policies. If affordability of existing Income Protection is a concern, then you can discuss your options with Experien as the product is very flexible with many options available. There has also been many changes to the life insurers offering such products. Some have closed down and many have been sold. If you have lost touch with your previous adviser or are unsure who your insurer may be, then you can also contact Experien for a complimentary review. Business (dental practice) insurance This is another important category of insurance for Dental Practice owners and provides protection against risks like property damage or from financial liabilities such as from management actions or injuries to patients at the practice. We have also helped many dental practices with business insurance claims and many of these relate to water damage. An insurer recently noted that more claims emerge for water than from fire
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for businesses operating in an environment like a dental practice. Business Insurance can be a complex product with many insurers offering more than 10 types of product sub options, like business interruption cover. This can be confusing, mistakes can be made, and a broker like Experien can guide you through the choices you need to make. We also see mistakes made when a self managed super fund of the Dentists owns the business premises of their dental practice but not the trading entity (which typically owns equipment and machinery). Mistakes are made when the business insurance policy components are not held in the correct name of each owner of the item of property, machinery or equipment owned. Professional indemnity insurance for dentists Like Income Protection insurance, we have seen significant price increases in this category of insurance. There are only a few insurers offering this cover including one that works exclusively with Experien. Some insurers mainly work through Associations where membership is either required to access the insurance or to avoid a higher price. We have also seen very large rises in premiums for General Dentists doing Orthodontics and Implants and also higher prices for Dentists in NSW than in other states. We have seen a rise in the number of Regulatory Notifications which in turn lead to professional indemnity insurance claims and also some high cost claims relating to Extractions that have led to issues.
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Practice owners should consider holding Professional Indemnity Insurance for their trading entity (and not just for their individual coverage) as many legal cases are brought against the trading entity (with or without action against an individual dentist). This is more likely in a practice with more than one dentist and where there are additional staff in the practice. Practice Indemnity Insurance arranged by Experien can be bought in one convenient package with individual cover without needing to bother with separate policies.
Read more from or experts in this magazine and watch out for upcoming
Visit Experien at www.experien.com.au or call 1300 796 577 to find out more This is General Information that is not based on your personal circumstances. Life insurance and Financial Advice services are provided by Experien Insurance Services Pty Ltd (EIS) ABN 99 128 678 937 and Experien Financial Services Pty Ltd (EFS) ABN 32 631 346 757. EIS and EFS are a Corporate Authorised Representative (No. 320626 and No. 1274354) of Affinia Financial Advisers Limited ABN 13 085 335 397 AFSL No. 237857. General insurance services are provided by Experien General Insurance Services Pty Ltd ABN 77 151 269 279 AFS Licence No. 430190 (EGIS) trading as Experien Insurance Services. Always read the Product Disclosure Statement of an insurer before considering to buy insurance.
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The series includes experts from Prime Practice, Cinch Dental, Humm, Experian Insurance, Dental Wallet & Henry Schein One and supported by the Henry Schein360 loyalty program. Visit our website to find out more about the upcoming webinars
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CLICK HERE
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NEW PRODUCTS
WATERLINE MANAGEMENT PRODUCTS
HENRY SCHEIN EuroSept Xtra Waterline treatment is used to reduce microorganisms in the water-bearing system of dental treatment units. A ready-to-use solution specifically for the automatic dosing systems of treatment units. •
EuroSept Xtra Waterline K6 or S water treatment is used to control the microbial population and prevents biofilm formation.
•
Automatic Dosing makes this an easy and efficient system for infection prevention
EuroSept Xtra Waterline K6 HS-9884289 Active ingredient: Hydrogen Peroxide Concentration: 6%
New ICX Renew Shock Treatment: Fast-Acting
EuroSept Xtra Waterline S HS-9884288 Active Ingredient: Hydrogen Peroxide Concentration: 1.41%
AD-90-1691-01
Fast-acting ICX Renew liquid shock treatment removes odor and foul-tasting bacteria in dental unit waterlines. Just mix the two solutions together into an empty water bottle, run through the lines, and soak overnight. After completing the shock treatment, flush the lines with water and resume your regular use.
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• • • •
Penetrates and removes the buildup of odor and foul-tasting bacteria Blue color lets you know the solution is hard at work in the waterlines Non-corrosive and gentle on equipment Will not corrode or clog waterlines
•
Odorless formula
NEW PRODUCTS
DIGITEST DIGITAL PULP VITALITY TESTER
Hone in on the Source of Your Patient’s Pain
•
Single tooth testing.
•
Intuitive single button operation.
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Multiple test settings to accommodate your personal preference.
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Self-calibrating for quick easy setup.
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Ergonomic design.
•
Four autoclavable probes (included) promote easy access to all tooth surfaces.
•
Standard 9V battery enables simple in-office replacement.
With the ability to offer the additional diagnostic test of electric stimulation using the Digitest® 3, dentists worldwide are routinely diagnosing and treating problematic teeth that otherwise might have to forgo treatment until a later date, when the problem more clearly presents itself. Stimulus adjustment control button
Digital display
..
Elevate Your Diagnostic Skills to the Next Level When percussion, ice, heat and radiographs are not enough, electric stimulation may be the diagnostic tool you need for determining the cause of the patient’s discomfort. That’s where the Digitest® 3 comes in.
.
.
.
Includes 4 autoclavable probes Ground Clip & Lead Wire
Digitest® 3 Pulp Vitality Tester (4) Autoclavable Probes; 1-standard long, 1-standard short, 1-labial, 1-lingual, (1) Ground Clip, (1) Lead Wire, (1) 9V Battery
How it Works The Digitest® 3 electrically stimulates the tooth to test for vitality. Comparing the response to the stimulus of the suspected tooth with a known healthy tooth’s response to an identical stimulus can help you hone in on the source of the patient’s pain.
Precision Probe Set | (2) Probes; one labial, one lingual Standard Metal Probe Set | (2) Probes; one short & one long Pulp Tester Ground Clip & Lead Wire | (2) Clips, (1) Wire
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NEW PRODUCTS
NEW DIAO A FUSION OF DIAMONDS AND PEARLS
Greater concentration of power, longer service life, better control. DIAO – the new generation of diamonds by Komet. With an innovative diamond coating: a fusion of diamond grains and ceramic pearls On average, 34 %longer service life compared to traditional instruments* A new generation of diamonds for preparations of unmatched quality • Concentrated power for exceptional durability • Optimum control • Rose gold colour for easy recognition during every-day work at the practice A powerful innovation with amazing durability. Crown preparation counts among the core jobs at the dental practice. A routine that demands a lot: Concentration, time and physical effort. Isn’t there a way of making these jobs easier and better at the same time? The answer: DIAO, with its innovative diamond coating that combines diamond grains and ceramic pearls. This combination creates concentrated power that can be applied with the utmost precision, giv- ing the instrument amazing durability and significantly prolonging the sharpness of its coating. You can rely on the instrument staying sharp over an extremely long time. That’s not all: DIAO is easy and comforta- ble to guide for perfect control.
Concentrated power for exceptional durability The combination of diamond grains and ceramic pearls leads to an unprecedented concentration of power that ensures an incredibly long service life. The optimal density of the coating guarantees that the instrument stays sharp for an exceptionally long time – a sharpness you can rely on time and time again. Optimum control Thanks to its innovative diamond coating, the DIAO can be guided smoothly and with ease, thus increasing the safety during the treatment. Easy recognition during everyday work thanks to the rose gold color DIAO supports the entire team every day at the practice. With its distinctive rose gold color, DIAO greatly facilitates the instrument management. The instruments stand out wherever they are, during the treatment, during reprocessing process or when placing the instruments back into storage. This contributes to a smooth workflow at the practice.
For optimum recognition facilitating the workflow in everyday use, DIAO is provided with an unmistakable color: a classy, mod- ern, radiant rose gold. *Source: Test lab Komet Dental, mechanical cutting test 2020
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DIGITAL
AUSTRALIA’S LARGEST DENTAL ONLINE STORE ONLINE
EXCLUSIVE ONLINE BENEFITS •
Speed up your consumable ordering
•
Select from over 30,000 products
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Track & Trace deliveries
•
Ordering templates to save time & money
•
View your backorder status
•
Pay your account quickly Online
•
Inventory Management Solutions
•
Online Live Chat - to resolve any questions
henry schein.com.au
SCHEINING PRICES AUGUST
VIEW HERE
Exclusive online only promotions every month
Offers valid for August 2022 1 3 0 0
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DENTAL EDUCATION HUB
UPCOMING CPD COU
YOUR FREE GO-TO RESOURCE FO
Explore over 270 hours of clinical and business related content all in one place with access to
Dr Gordon Christensen Clinical Courses
Restorative Options for Simplifying Complex Cases
Why you should use Reveal
Dr. Gordon J. Christensen Access courses online until January 2023
Professor Ian Meyers 1 CPD Credit | FREE Webinar Wednesday 3 August
Dr Bruce McFarlane 1 CPD Credit | FREE Webinar Thursday 4 August
READ MORE
READ MORE
READ MORE
Part 1 Incredibly Easy Shaping Techniques
Part 2 Obturation - How to use it
MicroMega One Reci Hands on Course | Canberra
Dr Biraj Patel 1 CPD Credit | FREE Webinar Wednesday 17 August
Dr Jorge Vera 1 CPD Credit | FREE Webinar Thursday 18 August
Dr Martin Habibi 3 CPD Credits | $199pp Canberra
READ MORE
READ MORE
READ MORE
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DENTAL EDUCATION HUB
URSES AND EVENTS
OR DENTAL EDUCATION AND CPD
o courses, webinars, podcasts and articles. View our upcoming courses and webinars below.
Understanding Fluoride Varnish
Bioceramics A Clinician’s Perspective
Intelligent Simplification of Direct Composites
Cathryn Carboon 1 CPD Credit | FREE Webinar Monday 8 August
Dr Lan Tran 1 CPD Credit | FREE Webinar Tuesday 9 August
Dr Michael Morgan 1 CPD Credit | FREE Webinar Thursday 11 August
READ MORE
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READ MORE
Hyflex Hands on Courses NSW Dr Humza Ahmed
Dr Bobby Patel 3 CPD Credits | $199 Multiple dates across multiple locations
Dr Shalin Desai
READ MORE
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SURGERY SETUP
INTRODUCING THE LOOKBOOK GET INSPIRED AND EMPOWER YOUR PRACTICE FOR A FUTURE IN DENTISTRY
The Lookbook showcases a selection of interviews, articles, 360° practice tour videos and testimonials from dentists, specialists and key opinion leaders utilising cutting edge technologies & advanced techniques in dentistry. Featuring successful case studies of practices from Australia and across the globe, the Lookbook presents a unique opportunity for dentists to gather insights about key elements of modern dentistry and how to integrate those business solutions into their own practice to create the perfect workflow. Understanding the complexity of managing a dental practice, this new concept displays integrated solutions, enhancing the way that practices operate by combining different aspects of dentistry, such as equipment, consumables, service, management software into one package. The articles are presented from a dentist point of view so doctors can easily relate the content to their own experiences managing their practices. The case studies below are a quick snapshot of what is to come in the Lookbook; so tune in, get inspired and empower your practice for a future in dentistry.
Life Dental chair. The innovative project features equipment solutions enabling easy access to the dental chairs, cart delivery, ceiling mounted light, wall mounted intra oral x-ray & concealed cabinet mounted suction. Furthermore, the facility has a fully dedicated Steri Room which was developed with focus on infection control and fluid workflow. For enhanced patient diagnosis, treatment planning and communication, the centre is equipped with the CBCT technology and intraoral scanner. The article also contains an interview with the equipment specialist, Tom Mathers commenting on the requirements for the Brånemark Center new practice, the challenges and the approach implemented by Henry Schein to deliver a fully customised solution. To access the full article including a 360° practice tour video and interview with Prof. Glen Liddelow and Dr. Graham Carmichael – please VISIT LOOKBOOK
The Brånemark Center - State Of Art Facility The Brånemark Center was the first osseointegration training centre in the southern hemisphere and has become an important centre nationally and internationally for the training of general and specialist practitioners in the entire spectrum of implant-based rehabilitation. After much planning & collaboration, the new state of art facility was inaugurated in January 2018. In order to meet with The Brånemark Center unique practice design, Henry Schein & KaVo in Germany worked closely to develop a customised KaVo 1058
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Expanding In-House Technologies and Services Elgin Park Dental With a focus on dental implants and oral surgery, Dr. Ceri Owen-Roberts used to frequently refer patients out to colleagues for CBCT scans. These are necessary for accurate diagnostics and treatment planning and offer greater visualisation than plain film. However, as the implant business grew, it was clear from the number of referrals being made that the practice would benefit from being able to perform CBCT scanning in-house. The benefits wouldn’t only be financial either.
SURGERY SETUP
In some cases, the ability to take a CBCT and get the results immediately, without sending the patient elsewhere first, can be a huge advantage.
For Dr Luke Heazlewood, Principal Dentist/Founder at Battery Hill Dental, the proverbial ‘stones’ represented unchartered territories in surgery fit out, finance and equipment selection.
To access the step-by-step article describing Dr. Ceri’s journey to introduce the CBCT technology into the practice, please VISIT LOOKBOOK
“I have never had to fit out or finance a shop before. Those were the grey areas that I needed to wade through,” says the young dentist, relating the difficulties he faced during the initial stages of establishing the community centred suburban clinic in the Sunshine Coast Region in Queensland. That was before Luke came across Surgery Setup Solutions - Webinar Series (formerly Surgery Setup Academy) – that turned out to be a gem of a discovery, attributed both to his online research and contacts he made throughout the years.
Battery Hill Dental – Solving the puzzle for your surgery setup “Crossing the river by feeling the stones” is a famous saying by former Chinese leader Deng Xiaoping that illustrates the process of doing something that is unfamiliar or unclear. It aptly describes the setup process that many dentists, taking the plunge to set up their first surgery, have to go through.
The full article will be released in August. For more information please VISIT LOOKBOOK Upcoming articles Adelaide Smile & Implant Centre
Northern Periodontics
Victoria Park Orthodontics
Morita X-800
A-dec 500
Planmeca Workflow
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ORTHODONTICS
REVEAL CLEAR ALIGNERS THE CLEAR CHOICE TO A BEAUTIFUL SMILE
Reveal is backed by over 40 years of innovative orthodontic solutions and over 50,000 cases globally in recent years. Reveal Clear Aligners are the clear choice for pre-restorative anterior
alignment treating Class I mild-to-moderate movement Aesthetic cases that accounts for 75% of malocclusions*
Case Description Patient Chief Complaint Diastema, missing lateral incisors 37 year old female
Generalised spaces present in upper and lower anterior segment. Upper and lower midline diastema. Missing both upper lateral incisors. Lower spaced arch.
Pre Treatment
Treatment Planning Close the midline diastema, align upper arch with space maintenance distal to upper canines and derotation of upper first premolars for future implants.
Number of aligners: Upper 20 Lower 20 Duration of treatment: 10 months No attachments. No IPR. No revisions
Final Results
Treatment Notes Initial risk factors presented by the patient: chances of aligner breakage because of missing teeth. During-treatment complications: none Post-treatment assessment: grade 2 bone loss associated with upper canines along with grade 1 mobility. * Data on file for US population
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ORTHODONTICS
Case Description
Patient Chief Complaint
Narrow upper arch, crowding, high canines 17 year old female
Alignment of upper and lower teeth
Pre Treatment
Treatment Planning Expansion of upper and lower arches. Extrusion of canines to correct open bite. Number of aligners: Upper 25 Lower 25
Duration of treatment: 14 months Adjunctive treatment: EBT, elastic button technique, for extrusion of upper and lower canines from 15 to 21 steps. No attachments. No IPR. No revisions.
Final Results
Treatment Notes Initial risk factors presented by the patient: none. During-treatment complications: grade 1 mobility of canines due to extrusive forces applied through, elastic button technique, EBT. Post-treatment assessment: Grade 1 mobility with grade 1 bone loss in upper & lower canines. Grade 1 bone loss in lower left lateral & central incisors.
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CASE BOOK
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COSMETIC & RESTORATIVE
G-ÆNIAL A’CHORD SIMPLICITY, AESTHETICS AND PERFORMANCE IN YOUR HANDS
Composite Veneers with simple layering. Beautiful polishability to achieve natural aesthetics using G-aenial A’CHORD
Pre-operative view. Cracks and chipped incisal edges.
Retracted labial pre-operative view.
Palatal shelf built using a palatal key using G-aenial A’CHORD shade AE.
Dentine layer using chromatic G-aenial A’CHORD shade AO2 to mask the tooth shade. A thin AE layer was placed as the final layer.
Line angles drawn in with pencil to create anatomy.
Final polishing shows G-aenial A’CHORD’s high polishability.
2-week review demonstrating G-aenial A’CHORD’s beautiful optical properties Clinical images courtesy of Dr Po Yang, Brisbane, Australia
CLICK HERE
Click to view for further information
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COSMETIC & RESTORATIVE
TWO TRULY UNIVERSAL PRODUCTS G-ÆNIAL® UNIVERSAL INJECTABLE AND ESSENTIA® UNIVERSAL
Welcome to the future with G-ænial® Universal Injectable a beautiful, high strength, universal composite applied with the irresistible convenience of direct injection delivery for faster application. Essentia® Universal offers the ultimate in simplicity. Just one shade with amazing blendability let’s you create aesthetic restorations with ease.
Caries excavation. A minimally invasive approach was implemented leaving affected dentine adjacent to the pulp chamber whilst ensuring the DEJ was free of any carious tissue
Oblique cusp-wise layering with G-aenial® Universal Injectable shade A3
Essentia® Red Brown Modifier (RBM)
Final occlusal layer stratified cusp-wise with Essentia® Universal paste
Final Stratification
Clinical Images Courtsey of Dr Bharat Agrawal
Pre-Operative Situation. Occlusal caries associated with tooth 47. Occlusal contact determined pre-operatively to assist in replication of final morphology
CLICK HERE
Transform
the way you
work
Start injecting with our strongest direct restorative ever*
G-ænial® Universal Injectable
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DR BHARAT AGRAWAL Gold Coast, Queensland
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COSMETIC & RESTORATIVE
END-TO-END COMPOSITE RANGE YOUR COMPREHENSIVE WORKFLOW SIMPLIFIED
GC composites are designed utilising optimised properties for outstanding performance both functionally and aesthetically. The full GC range of composites allows you to choose your preferred handling and shade system that will ensure predictable aesthetic outcomes. GC’s filler technologies offer excellent physical properties to achieve durability, wear resistance and polish retention. Each of our universal composites showcases a high level of quality that is core to GC’s product philosophy. 1. Select your composite of choice
FIRM
FLUID
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Gænial Flo X
everX Flow
Gænial Universal Flo
Essentia HiFlo
Essentia LoFlo
4 Gænial Universal Injectable
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Essentia LE
Gradia Direct X
Gænial Anterior
Gænial Posterior
Essentia DE
Essentia LD
Essentia OM
Essentia MD
9 Gænial ACHORD
Essentia DD Essentia Universal
2. Bonding Protocol G-Premio BOND
G2- BOND Universal
Your choice of both HEMA free universal adhesive systems in either a single bottle or two step approach, easy to apply with strong and durable results.
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COSMETIC & RESTORATIVE
3. Placement Technique Modeling Liquid
Aids in fast & efficient application of all direct composite materials. Applied on a brush and/ or instrument, it eases the placement & shaping of composites and helps to achieve good morphology and a smooth finish.
Composite Manipulation Brush Kit
To aid and assist with the manipulation of composites. Ideal for composite stains and tints.
4. Finishing Epitex
Aluminium Oxide abrasives for contouring, finishing and polishing of interproximal composite, compomer and glass ionomer restorative surfaces and prophylactic cleaning.
New Metal Strips
New Metal Strips are electro-plated with aluminium-oxide particles. The strips will not stretch or break, and the excellent wear resistance and superior abrasive bonding allow wet finishing, which assures long-lasting and repeated use.
5. Polishing Diapolisher Paste
CLICK HERE
An impressive gloss level can be obtained by just some simple polishing steps, utilising standard polishing wheels and points.
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For further information
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COSMETIC & RESTORATIVE
THE PAST, PRESENT AND FUTURE OF ADHESIVE DENTISTRY INTERVIEW PROF. BART VAN MEERBEEK
As co-editor-in-chief of the Journal of Adhesive Dentistry, Prof. Bart Van Meerbeek is one of the most respected authorities on the topic of dental bonding agents. Here, he discusses how they have advanced over the last three decades and what the future of adhesive dentistry might look like.
Prof. Van Meerbeek, how have bonding agents changed and advanced since you first began studying them? I believe that the great progress dental adhesive technology has undergone in the last 30 years, and the progress in bonding agents in particular, has had a great impact on the field of dentistry and particularly on restorative dentistry, of course.
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to the substrate, you first need to do something with this smear layer.
Many of the current restorative dental procedures make use of adhesive materials and techniques and have advanced greatly compared with when I wrote my dissertation more than two decades ago on the topic of adhesion to dentine.
After this, we entered the era of conditioners and primers. In the past, the restorative community had been a little bit afraid of using phosphoric acid owing to its potential for pulp irritation. More and more, however, dental professionals began to use etchants with this chemical in them, as well as primers that effectively promoted bonding between the adhesive resin and dentine.
Adhesion to enamel is, of course, relatively easy to achieve in comparison with adhesion to dentine, and when I first started researching this topic, I was limited to conducting clinical trials in which we were confronted with a relatively high number of restoration losses in the short term.
While having achieved excellent bonding performance with multistep adhesives in the laboratory, as was later confirmed in clinical studies, further design and development of adhesive materials next focused on simplification and shortening of bonding procedures.
I was lucky to have been able to witness first-hand the fast advancements dental bonding has made, having conducted research in this field now for nearly 30 years.
Out of this, two kinds of adhesives, making use essentially of two different bonding modes, arose: the etch-and-rinse adhesives and the self-etch, or etch-and-dry, adhesives.
At a certain point, the research community started to realise that there is a smear layer in-between, which is created through cavity preparation, and that this layer interferes with bonding. If you want to achieve successful micromechanical and chemical bonding
The newest generation of universal adhesives now enables dental practitioners to choose which of the two bonding modes to apply with one single adhesive formulation.
COSMETIC & RESTORATIVE What advantages do bonded restorations offer over more traditional methods? Bonded restorations are minimally invasive—the dentist doesn’t have to remove non-diseased tissue to create undercuts to keep the restoration in place, allowing for a more conservative approach. Keeping as much enamel as possible should be a goal of any restorative procedure, as it is simply the best tissue to bond to. Although bonding to dentine has always remained more challenging and has actually slowed down our adhesive endeavours for a long time, adhesively restoring teeth, involving also effective bonding to dentine, can today be achieved in a reliable, predictable and durable way. Along with highly successful implantology to replace missing teeth, lessening the need for bridges, solitary tooth restorations have substantially increased in number. Bonding promoted the additional shift from conventional tissue-invasive crowns to tissuepreserving partial tooth restorations, as modern adhesives can hold such partial restorations in place on rather flat and even non-retentive surfaces. In addition, bonding procedures allow for more natural-appearing restorations to be achieved by techniques to adhesively lute aesthetic restorations made of glass-ceramics and even the strong zirconia ceramics that no longer can be considered nonbondable. What is your opinion regarding the current generation of universal adhesive solutions? I think that this generation is very good, but that they are still not always as good as the more traditional gold standard two-step self-etch and three-step etch-and-rinse adhesives when it comes to their intrinsic bonding potential to dental tissue. However, I do see it as a positive that many of these universal adhesives integrate the MDP monomer, which should be considered to be one of the best functional monomers available today, though it needs to be present at a high concentration and purity level. The MDP monomer is, generally speaking, excellent at bonding to zirconia as well. When it comes to bonding to different kinds of ceramic as well as resin-based composite restorative materials, it is
always helpful to know which universal adhesives contain silane and are claimed to no longer need further treatment of the restoration. This has the advantages of lower technique sensitivity and fewer procedural steps—provided that it does, of course, work. There is current scientific evidence that the silane incorporated in today’s acidic aqueous universal adhesives is, however, insufficiently stable. Fortunately, research is underway to develop new universal adhesives that contain other silanes with higher stability in water at higher acidity. Overall, I believe that a restoration primer that contains a high concentration of silane along with the MDP monomer is still more effective than many universal adhesives for bonding to restorative materials, since these universal adhesives can contain many other ingredients that create a kind of competition within the material to reach and interact with the substrate surface, leading to lesser bonds. Another shortcoming of universal adhesives is their thin film thickness and relatively high hydrophilicity, promoting water uptake and hence making them sensitive to hydrolytic degradation. In this light, it’s important to note that, when a viscous and hydrophobic flowable composite is applied on top of a universal adhesive, it can make up for this somewhat and allow for durable bonding to take place. Is the MDP monomer crucial to the ultimate success of universal adhesives? Are there other factors that can influence this? Well, it’s very clear that the MDP monomer is one of the most effective monomers available, given its primary chemical binding potential to hydroxyapatite. However, there are significant differences in the MDP monomer purity and concentration levels between these products, factors that are affected by whether or not the monomer is synthesised by the company itself or whether this process is outsourced. Essentially, a universal adhesive that contains a high concentration of very pure MDP monomer should perform the best.
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COSMETIC & RESTORATIVE Are there any specific advantages that a selfetch adhesive possesses? The biggest advantage is that it doesn’t remove all hydroxyapatite and minerals present in dentine and so keeps the weaker dentinal collagen protected. Phosphoric-acid etching results in relatively deep and complete demineralisation with collagen exposure, making the bond more prone to degradation. Partially maintaining minerals around collagen using a mild self-etch adhesive additionally allows for strong ionic bond formation to take place when the adhesive in particular contains the functional monomer MDP. In addition, one should be aware that, while chemical binding doesn’t necessarily lead to higher bond strength, it can create better long-term bond durability. What do you see as the next step in adhesive dentistry? One possibility is to reduce the number of steps in the adhesion process with the final goal of having self-adhering restorative materials. There have been developments in this direction, including studies and commercial products, though the products haven’t always proved to be very effective and their bond durability is unclear.
PROF. BART VAN MEERBEEK Co-editor-in-chief of the Journal of Adhesive Dentistry
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Now, however, there are newer materials coming to market with claims that they can be used with no pretreatment. Their clinical effectiveness, nevertheless, still needs to be proved and guaranteed before such self-adhering restorative materials could be used as true amalgam alternatives in routine dental practice. Another possibility, and current R & D hype, is the development of bioactive adhesives. Many dental researchers and many companies want adhesives not only to deliver good bonding performance but also to have certain therapeutic benefits. What exactly a bioactive adhesive is depends on who you’re talking to. Some researchers believe that they should have antibacterial qualities, whereas others state that remineralisation of dentine and pulpal cell interaction are needed to qualify for the term “bioactive”. We certainly need to investigate whether we can give these materials these additional properties, but on one condition: that the adhesive material does not lose any of its original bonding abilities. That, in my opinion, is the biggest challenge for the future of adhesive dentistry.
COSMETIC & RESTORATIVE
INITIAL LISI BLOCK LITHIUM DISILICATE CAD/CAM BLOCK FOR CHAIRSIDE SOLUTIONS
Lithium disilicate block for one appointment dentistry
Initial LiSi Block is a fully crystallized lithium disilicate block that delivers optimal physical properties without firing. This unique block features GC’s proprietary HDM (High Density Micronization) technology for CAD/ CAM dentistry to deliver high wear resistance, smooth margins and aesthetic final results.*
Initial LiSi Block can dramatically reduce process time: no need to fire, glaze, characterise and cool. This saves up to 40% in the time^ required to create your restorations, also reducing the chair time for you and your patient.
Initial presentation, large failing composite resin on tooth 36
Completed preparation
Milled Initial LiSi restoration shade A2 LT
Hand polished LiSi restoration
Bonded Initial LiSi restoration ready for clean up
Hand polished LiSi shade A2 LT, immediately post op. Total treatment time 1 hour and 15mins
For further information CLICK HERE
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Clinical Images courtesy of Dr Lawrence Lau, Sydney
You just need to mill, polish and place.
This makes it an ideal, time saving solution for single visit chairside treatments.
^ Under testing conditions based on IFU *Source: GC R&D, Japan, Data on file
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COSMETIC & RESTORATIVE
ADVANCED MATERIAL SCIENCE DESIGNED TO SIMPLIFY
We shine a light on 4 of Kuraray’s most-loved DPS Best Products and members of its successful CLEARFIL and PANAVIA product lines. Despite getting its start in the early 1900s manufacturing synthetic fibres, today, Kuraray Noritake Dental is known to clinicians as a restorative powerhouse - especially to those who have relied on its advanced material science for years to achieve consistently successful restorations. One reason for Kuraray’s success is the company’s introduction of adhesive monomers to dentistry nearly 4 decades ago. Years of careful research ultimately led to the development of the MDP monomer, whose molecular structure yields greater adhesion and a stronger chemical bond to enamel, dentine, metal, and zirconia. It is the foundation of all products in Kuraray’s CLEARFIL and PANAVIA product lines, and likely what has led teams of clinicians to crown several of these materials as DPS Best Products. CLEARFIL: A Strong Bond and Aesthetic Fill For restorative dentists, building a strong restoration calls for an artful combination of technique and materials. To satisfy the latter, Donald Jetter, DMD, relies on CLEARFIL adhesives and composites. “We have been using Kuraray’s CLEARFIL composites and bonding materials in our practice for a very long time now,” he shared. “Our dental supply rep first suggested the material to us as a cost-effective alternative to the composite we were previously using, and that she always received positive feedback from other doctors who had tried it. I reluctantly ordered some and have never looked back.”
After using CLEARFIL MAJESTY ES-2 in the A2 shade for several years with success, Dr. Jetter was excited to try out CLEARFIL MAJESTY ES-2 Universal, a singleshade composite for posterior restorations. It uses Light Diffusion Technology to mirror the way tooth structure distorts light,resulting in a virtually seamless blend between the restoration and surrounding dentition. Additionally, enamel-like translucency allows for easy polishing to a high gloss. “The new universal shade seems just a bit lighter than the A2 shade but works well to match adjacent tooth structure,” said Dr. Jetter. “I tried another universal shade product that came out prior to CLEARFIL Universal, but I experienced material failure with it, and it did not handle as well as Kuraray’s material.” CLEARFIL MAJESTY ES-2 Universal pairs well with CLEARFIL Universal Bond Quick, a singlebottle adhesive that houses both the original MDP monomer and AMIDE-based chemistry, which rapidly permeates dentine and enamel to eliminate waiting time and dramatically reduce water absorption. Together, the two monomers provide a unique Rapid Bond Technology. Dr. Jetter and his team have been using CLEARFIL Universal Bond Quick since it first came to market, after successfully using its predecessor, CLEARFIL Universal Bond, for many years. “I like these products because they are single-bottle, fluoridereleasing, universal adhesives with low odour that help achieve less postop sensitivity,” he shared. “I would highly recommend CLEARFIL MAJESTY ES-2 and CLEARFIL Universal Bond Quick to other
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COSMETIC & RESTORATIVE
dentists, as they’ve helped me create long-lasting and aesthetic composite restorations with little to no sensitivity for my patients.”
“It is a self adhesive, radiopaque, dual-cure resin cement that bonds to enamel, dentine, composite, semi-precious and precious metal, porcelain, fibre posts, and zirconia. It’s easy to dispense and even easier to clean up. Fast setting time, no need to refrigerate, and no postop sensitivity. That all adds up to no headache. I recommend it to anyone looking to simplify their cementation protocols without losing any bond strength.”
PANAVIA SA Cement Universal: Cementation Simplified Designed to remove both primer and silane from the cementation procedure, PANAVIA SA Cement Universal contains not one, but two monomers: the original MDP monomer and the LCSi monomer, which allows for a strong bond to porcelain, lithium disilicate, and composite resin.
PANAVIA V5: ‘V’ is for Versatility The strongest dentine bonding cement that Kuraray has ever developed, PANAVIA V5 simplifies cementation of crowns, bridges, inlays, onlays, veneers, and posts and cores. PANAVIA V5’s MDPbased Tooth Primer offers high bond strength in the self-cure mode thanks to unique catalyst technology, while a 1-bottle surface treatment applies to all indirect restorations.
“In my 12 years of clinical practice, I have tried using a variety of different cements and what I find myself gravitating toward is the versatile powerhouse of Kuraray’s PANAVIA, which makes sense since Kuraray revolutionised bonding by introducing the MDP monomer to the world,” said Bilyana Tesic, DDS, who practices in Monterey, CA.
“I loved being able to cement a metal post-and-core and ceramic crown all at the same time with the same product,” said Dr. J. Jerald Boseman, who took part in the DPS product review of PANAVIA V5. He added that the cement was easier to use, had a longer set time, and was less technique-sensitive than similar products.
After using earlier generations of PANAVIA cements, which required mixing several bottles together before application, Dr. Tesic was excited when PANAVIA SA Cement Universal changed all that. “PANAVIA SA Cement Universal simplified this process into a single step delivered via automix dispenser. Voilà! One cement to rule them all.”
Available in 5 shades - White, Brown, Universal, Clear and Opaque - with corresponding try-in pastes, PANAVIA V5 offers easy removal of excess cement after light-curing. Just one drop creates a durable bond to hydroxyapatite, metals, composites, and zirconia.
Dr. Tesic has been using PANAVIA SA Cement Universal for the past two years, and what she appreciates most about the material is its versatility.
“So far, the retention has been good with excellent handling properties,” shared J. Michael Heider, DDS, who has also used previous generations of PANAVIA products. “I’m glad to see the best characteristics of PANAVIA are being improved further.”
The Crown and Bridge Duo Kuraray offers this pair of products for a simplified, reliable process designed for a range of restorative procedures. PANAVIA SA Cement Universal
KATANA Zirconia
All-in-one bonding solution that can be used without a separate primer because it adheres to virtually all restorative materials. Using a silane coupling agent built into the paste, it delivers a strong, durable chemical reactiveness with zirconia, dentine and enamel.
Innovative multilayered block specialised for the fabrication of full-contour zirconia prosthetics at chairside; it reflects natural opacity and comes with natural colour gradients as a dentine-like base for restorations, eliminating timeconsuming challenges in staining a restoration.
DR. DONALD JETTER DMD Article from Dental Product Shopper March 2022
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SMILE MAKEOVER USING A MINIMALLY INVASIVE MULTI-DISCIPLINARY APPROACH
In this case, a female patient in her late 30s presented to the practice with moderate upper anterior crowding, a discoloured upper left central incisor and defective composite restorations in the upper central incisors (Fig. 1). Unhappy with the overall aesthetics of her smile, the patient was keen to undergo a smile makeover using a minimally invasive treatment pathway.
To help ensure the patient made an informed decision, several treatment options were discussed including orthodontics, tooth whitening, composite resin restorations and ceramic veneers. After consultation, the patient chose the more conservative option of composite restorations, following comprehensive orthodontics and tooth whitening. By opting for the less intrusive – and also more cost effective – process of alignment, bleaching and bonding, all of the patient’s concerns were addressed safely and effectively. Alignment and bleaching The upper anterior crowding was resolved by using a removable appliance to expand the arch followed by a conventional fixed appliance to align the anterior labial segment. The orthodontic treatment took approximately 12 months (Fig. 2 and 3). Once the anterior crowding had been remedied using conventional fixed appliances, tooth whitening was carried out on the upper left incisor using the inside/outside technique to correct the internal discolouration. For this, an Essix retainer was used with 16% carbide peroxide gel, with instructions given to wear the tray at all times for three to five days changing the whitening gel twice a day during this time (Fig. 4 and 5). After five days of whitening, the access cavity of the upper left central incisor was sealed and the patient was instructed to wear the tray at night-time only using the whitening gel to whiten the rest of the
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upper arch (Fig. 6 and 7). Once a satisfactory shade was obtained, there was a pause in treatment for three weeks prior to restoring the central incisors with direct composite resin restorations, to allow the oxygen to dissipate from the teeth, which would otherwise have interfered with the bonding process. Restoration For the third phase of the treatment process, the aim was to improve the shape of the central incisors as well as replace the defective Class III composite restorations. This was achieved with a single shade composite, which is both effective and convenient for restorations of this nature. In this instance, BRILLIANT EverGlow shade A1/B1 from COLTENE was chosen, as the universal composite works well as a single shade composite and it doesn’t run or stick to instruments, thus allowing for easy modelling of the composite resin. BRILLIANT EverGlow also features a Duo Shade system, which allows the composite to blend in well with the adjacent tooth structure making the restoration look virtually invisible (Fig. 8, 9 and 10). A white opaque tint from the MIRIS 2 range, also by COLTENE, was used to mask discolouration on the cervical area of the upper left central incisor. Free hand incremental build up technique was utilised to restore the central incisors with direct composite resins. To finish, the restorations were polished using a fine diamond followed by alumina impregnated silicone points and fine Sof Lex discs.
COSMETIC & RESTORATIVE
Fig. 1: Patient’s preop occlusion
Fig. 2: Pre-op smile
Fig. 4: Prep for inside/ outside whitening
Fig. 5: Essix retainer used for whitening
Fig. 3: Pre-op intraoral view
Fig. 6: Inside/outside whitening post-op
Review As the BRILLIANT EverGlow polishes to a very high lustre and is incredibly durable thanks to its submicron particle filler particle size (Fig. 11), I am pleased with the result of the restoration. As for the orthodontic aspect of the treatment, both central incisors are now proportionate resulting in a more aesthetically pleasing smile. As such, the patient is extremely delighted with the treatment
outcome, which she says has “exceeded her expectations” (Fig. 12). Nadeem Younis is a Principal Dentist at Bridge Dental Practice in Burnley and a full member of the British Academy of Aesthetic Dentistry (BAAD). Here, he presents a smile makeover case using a minimally invasive multidisciplinary approach.
Fig. 7: Upper arch whitening post-op
Fig. 8: Preparation of upper central incisors for
Fig. 9: Composite build up
Fig. 10: Polished composites upper centrals
Fig. 11: Post treatment
Fig. 12: Final smile
To view the BRILLIANT EverGlow range on our website CLICK HERE
DR. NADEEM YOUNIS, BURNLEY/LANCASHIRE APRIL 2018
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FOUR THINGS TO KNOW ABOUT ZIRCONIA BY DR DINESH SINHA
Since the early 2000’s, the global all-ceramic restoration market, including that for zirconia, has been growing rapidly. Increasing market demand resulted in various dental manufacturers marketing different dental zirconia types that can be used in many dental prosthetic applications. Today, dental ceramists play a key role with the latest CAD/CAM technology to provide high performance zirconia prosthetics with more precision and aesthetics for treatment needs. Zirconia is a polycrystalline ceramic. This means that it is entirely composed of crystals, with no glass phase. The presence of an entirely crystalline microstructure brought strength to zirconia and gave initial formulations an opaque appearance with low translucency. The translucency of zirconia is improved by changing the atomic arrangement within the crystals of zirconia (most commonly known as translucent or aesthetic zirconia). There are several key factors dental ceramists should know when selecting zirconia:
3Y is the strongest and least translucent, whereas 5Y is the highest translucency and lowest strength. Most dental zirconia manufacturers purchase raw zirconia powder from a third party. Only a few manufacturers like Kuraray Noritake Dental Inc. use their own proprietary original zirconia powder formulations (Figure 1). The company can thereby more accurately control the chemical and physical make-up, not only with Yttria concentration, but also parameters like grain or particle size, as well as sintering temperature. Kuraray Noritake has KATANA™ as an umbrella brand with three different options of strength and translucency in multi-layered formulations: KATANA™ Zirconia ML, STML and UTML.
1. Type/brand of zirconia During the industrial process of making dental zirconia (zirconium dioxide), Yttria (Y2O3) is added to make refined zirconia stable at room temperature. Yttria also contributes to increasing the translucency of zirconia, but also conversely reduces its strength. The most common method of classifying zirconia is by Yttria concentration (i.e., 3Y, 4Y & 5Y). Many dental manufacturers use/buy zirconia from one large industrial ceramic manufacturer. This classification helps to understand and describe the properties of zirconia where the primary powder source is the same.
Fig. 2. 3-point Bending Flexural Strength Test
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Fig. 1. Kuraray Noritake Dental Inc. original KATANA™ Zirconia powder.
Fig.3. Biaxial Bending Flexural Strength Test
COSMETIC & RESTORATIVE 2. Strength of dental zirconia Strength differs in each layer, providing enamel with 750 MPa, the transition-body with 1000 MPa, and the base layer with 1100 MPa flexural strength.
The most common method of measuring ceramic strength is by evaluating its flexural strength. The flexural strength test applies a force on the top of a ceramic specimen, which causes the specimen to bend and fracture. The International Standards Organization (ISO) and the American Dental Association have developed a standard for measuring the flexural strength of dental ceramics.
These layers are perfectly harmonized with each other, since all fundamental production steps, including purification, refining of the zirconia raw material and the addition of essential components such as Yttria, are all processed in-house by Kuraray Noritake.
Two methodologies are commonly used today. In the 3-point bend method (Figure 2), a rectangular specimen is used, whereas in the biaxial flexural strength method (Figure 3), a circular specimen is incorporated. Both tests are acceptable, however, ceramics tend to produce higher values when tested with the biaxial method over the 3-point bend method.
4. Bonding to zirconia There are several clinical situations where zirconia restorations benefit from resin bonding: restorations that are less strong or thin, lack retention, or rely on resin bonding, (ex. resin-bonded fixed partial prostheses, onlays, or laminate veneers).
Furthermore, even in a 3-point bending test, if the span length (see Figure 2) of the specimen is decreased, it can produce higher values of flexural strength of the same ceramic. It is critical to understand testing parameters when selecting or comparing different ceramic brands.
Prof. Markus Blatz, DMD, PhD, University of Pennsylvania School of Dental Medicine and his group introduced a three-step approach, known as the “APC Zirconia Bonding Technique”.
All materials should be tested under the same conditions, and by using the same methodology.
APC Step A: Air-particle abrasion, then application of P: Primer and finally Step C: Composite resin. MDP-based resin cemented restorations exhibit better margins long term. MDP has shown a very stable chemical bond to zirconia. Kuraray Noritake invented and introduced the Original MDP monomer in 1981.
3. Multi-chromatic vs multi-translucent Kuraray Noritake was the first dental manufacturer to introduce multi-layered zirconia as a commercial product in 2013. Different concentrations of pigmentcontaining zirconia powder are utilized to make the zirconia discs and blocks multi-chromatic.
All Kuraray Noritake PANAVIA™ cement (Figure 5) brands contain this original MDP monomer.
Multi-chromatic: KATANA™ Zirconia ML/STML/UTML were developed based on the concept of “lifelike appearance”, accurately and naturally mimicking the colour and translucency of natural teeth. It has a top enamel layer, two transition layers, and a base body layer.
Fig. 5. Universal resin cement: PANAVIA SA™ Cement Universal
The unique manufacturing technology from Kuraray Noritake allows each powder layer to seamlessly blend within a gradient profile that eliminates any demarcation lines between the different layers. The Yttria concentration remains similar in all layers; therefore, the strength of the zirconia does not deviate from layer to layer. The pigments (chroma) are adjusted in a way that produces different chroma among the layers, where the translucency stays the same.
Kuraray Noritake is known for its legacy of inventing groundbreaking technologies in both resin and ceramic technologies. The company is committed to inventing the best quality materials that dental ceramists and dentists can use to treat their patients with confidence.
Multi-translucent: KATANA™ Zirconia YML (Figure 4) is the latest KATANA™ multi-layered disc, with a well-balanced combination of colour translucency and flexural strength gradation. It is also manufactured using multilayer technology, with different Yttria content in each layer.
DR DINESH SINHA BDS, PHD, Senior Technical and Marketing Manager Dental Division, Kuraray America, Inc.
Fig. 4. KATANA™ Zirconia YML
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COSMETIC & RESTORATIVE
PREMOLAR CASE WITH CLEARFIL MAJESTY™ ES-2 UNIVERSAL
Case Background A stable ASA 2 65 year old female presented to the practice for restorative dentistry with a medical history significant for a non-descript immunoglobulin deficiency, for which she receives regular infusions. She reports no known drug allergies. Clinically, she was diagnosed with an occlusal peripheral rim fracture leaving a food trap on tooth 14 (FDI notation). Tooth 15 featured an extensive amalgam with extreme proximity to the distal marginal ridge, which exhibited distal vertical axial fractures as a result of cyclic expansion-contraction over time. The restorative goal of minimally invasive direct dentistry would be complicated by the undoubtedly dark dentin substrate under the amalgam. A material was sought that featured both an excellent chameleon mechanism as well as physical properties to maximize the prognosis of direct restorations in this area. Restorative Procedure
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The patient was subjected to topical anaesthetic prior to buccal infiltration using 1 carpule of 2% Lignocaine with 1:100,000 epinephrine. A rubber dam was affixed prior to preparation of tooth 15MO with dissection of the distal vertical marginal ridge fracture. The margins of tooth 14O and 15MOD were refined before bevelling as the ends of enamel rods facilitate better bonding relative to the sides of enamel rods. A 27 micron aluminium oxide micro air abrasion treatment was completed prior to affixing, wedge and matrix to reconstruct the mesial marginal ridge of tooth 15. A matrix-in-matrix solution was used to recreate the proximoaxial contour of 15D This provided hermetic closure at the proximogingival cavosurface margin as well as an ideal contour for the missing axial wall.
Since the dentin base was heavily stained, CLEARFIL MAJESTY™ Flow was used before utilizing CLEARFIL MAJESTY™ ES-2 Universal in a lobe-by-lobe creation of occlusal anatomy.
Following a total etch technique, a 2% Chlorhexidine scrub was completed for 30 seconds and the dentin blot dried to a moist state. A 5th generation bond was applied, air thinned and cured as per manufacturer instructions. Microlayers are important during the delicate first 5 minutes of hybrid layer formation, and were completed using 0.25mm increments of CLEARFIL MAJESTY™ Flow (Kuraray Noritake Dental Inc.). This technique can be expected to increase significantly the shear bond strength to dentin (1, 2). This was completed both in the proximal box floor area as well as mid-occlusally. The marginal ridge was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.).
CLEARFIL MAJESTY™ ES-2 Universal is at the forefront of a simplified restorative armamentarium for the modern practice.
Post-operative occlusal checks verify that the restoration is conformative to occlusion and esthetically excellent with no visible marginal show. Rationale for Material Choice The marginal ridges were microlayered horizontally as was the floor of the resulting Class I preparation as per a reduced layer thickness-technique modification of Nikolaenko et al (3), whereas the highest shear bond strengths were found when a 1mm horizontal layering technique was used.
It takes cloud-shading one step further by offering a “Universal” shaded composite featuring Light Diffusion Technology (LDT) with simultaneous ideal sculptability, optical metamerism and physical properties for use in any restorative situation in the mouth. Featuring barium glass nano fillers and proprietary pre-polymerized nanoparticle fillers, the latter boasts a high refractive matrix that is able to disperse light and fool the eye with even the thinnest of layers, obviating the need for opaquer composites in cases like the one featured.
COSMETIC & RESTORATIVE
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When paired with CLEARFIL MAJESTY™ Flow in a conservative layered technique, the 81% filled flowable produces a radiographically well-demarcated layer, and the superficial CLEARFIL MAJESTY™ ES-2 Universal boasts an easy-to-polish robust single shade restorative solution that will virtually fulfil all of your restorative needs for non-bleaching patients. Physically, with compressive strength is rated at 348MPa and flexural strength at 116MPa, CLEARFIL MAJESTY™ ES-2 Universal is in the range of natural enamel and dentin. The built-in fluorescence is very enamelomimetic, which is excellent for nightclub social situations.
References 1. Bertschinger C, Paul SJ, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength. Am J Dent. 1996;9(3):115-119
2. Magne P, Kim TH, Cassione D, Donovan TE. Immediate dentin sealing improves bond strengths of indirect restorations. J Prosthet Dent. 2005;94(6):511-519
3. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Franenberberger R. Influence of C-Factor and layering technique on microtensile bond strength to dentin. Dental Mater. 2004;20(6):579-585
Dr Clarence Tam is originally from Toronto, Canada, where she completed her Doctor of Dental Surgery and General Practice Residency at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice is limited to cosmetic and restorative dentistry and she is well-published to both the local and international dental press, writing articles, reviewing and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally. Clarence is the Past Chairperson and Director of the New Zealand Academy of Cosmetic Dentistry. She is currently one of two individuals in Australasia to hold Board-Certified Accredited Member Status with the American Academy of Cosmetic Dentistry. Clarence is an Opinion Leader for multinational dental companies Kuraray Noritake Dental Inc., J Morita Corp., Henry Schein NZ, Ivoclar Vivadent, Dentsply Sirona, 3M, Kerr, GC Australasia, SDI and Coltene and is the only Voco Fellow in Australia and New Zealand. She holds Fellowship status with the International Academy for DentoFacial Esthetics and is a passionate and approachable individual, committed to having an interactive approach with patients in all of her cases to maximize predictability.
DR CLARENCE TAM HBSc, DDS, FIADFE, AAACD Auckland, New Zealand
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COSMETIC & RESTORATIVE
SIMPLISHADE REVIEW BY AODHAN DOCHERTY
As a practice owner and dentist who loves restorative and cosmetic dentistry, there are some major challenges I face day to day. Technical difficulties: shade selection is one of the most common problems that my associate dentists come to me and ask for help with. Many practices often have a fishing tackle box filled with different types of composites, enamel shades, body shades, dentine shades and effect enamels. We all know that sometimes having too much choice can over complicate things. Secondly, many dentists do not have the technical knowledge on how to perform difficult layering techniques and often we do not have the time to do these in clinical practice. From a business perspective having to hold too much stock is not feasible or practical for most.
There are many times where composite shades are purchased and then wasted and go out of date costing the practice needlessly. Simplishade has helped us address these challenges. By simplifying the shade selection right down there is far less guess work and less time waste. There is also no need to perform complex layering techniques, however you still have the option to cut back incisal edges and place Harmonize shades or effect enamel. Reducing the inventory/ stock is also a major advantage and a big cost saver to the practice overheads.
Edgebonding to address wear/tear and outline form (light shade) Before
After
To view Simplishade on our website
Composite resin veneers for poorly shaped incisors (light Shade) Before
After
CLICK HERE
Addition of composite resin to address broken front teeth (Medium Shade) Before
After
AODHAN DOCHERTY
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COSMETIC & RESTORATIVE
TEETH WHITENING TRIO OF TECHNIQUES
Whitening is a treatment of choice to equalize and lighten the colour of teeth, or when they feature different saturations. In this case, the patient presented root canals in teeth 1.1 and 1.2 performed two years ago, but with darkening only on tooth 1.1. Teeth whitening should always begin with the most saturated tooth, and tones should be gradually matched to ensure that the tooth’s response is positive to the treatment, thereby averting the risk of exacerbating the discrepancy in tones.The technique of choice in this case was to first perform an internal whitening with 35% carbamide peroxide (PolaDay CP 35%, SDI), combined with night bleaching with 16%
carbamide peroxide (PolaNight 16%, SDI) exclusively on tooth 1.1. Internal whitening replacements were conducted three times, five days apart. Upon confirming that the saturation of 1.1 was subsiding, it was decided to close the access to the pulp chamber and to continue with the night whitening, adding 16% carbamide peroxide on the canines and, subsequently, the rest of the teeth. This procedure was continued for a month and a half.To complete the treatment, a session was held at the dental offices with 37% hydrogen peroxide (PolaOffice +, SDI).
Fig 1 Patient’s smile on the first visit
Fig 2 Initial colour measurement of the
Fig 3 Initial colour measurement of the
Fig 4 X-ray of 1.1 and 1.2 to confirm that
Fig 5 Pulp chamber opening on 1.1
Fig 6 Evolution of the incisal third of
Fig 7 Evolution of the cervical third of
Fig 8 Evolution of the incisal third of 1.1
Fig 9 Evolution in the cervical third of
Fig 10 Final result of the whitening. A
Fig 11 Final photo of the smile, for
Fig 12 Colour measurement at the end
to eliminate residue of gutta-percha and apply 35% carbamide peroxide for internal whitening
1.1 after the second replacement of 35% carbamide peroxide
middle and incisal third of 1.1
1.1 after the first replacement of 35% carbamide peroxide.
positive response by 1.1 with internal plus external whitening is observed. Tooth 1.2, despite endodontic treatment, responded well to treatment with external whitening alone.
cervical third of 1.1
1.1 after the first replacement of 35% carbamide peroxide.
comparison with the initial photo.
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the state of the endodontics is adequate and that an internal whitening treatment can be performed on tooth 1.1.
after the second replacement of the 35% carbamide peroxide
of the treatment, after the application of 16% carbamide peroxide on the rest of the teeth and after the office consult session with 37% hydrogen peroxide.
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PAIN CONTROL
IN TIME OF CRISIS CONFIDENCE IN YOUR KEY PRODUCTS IS ESSENTIAL
As the world leader in Pain Management (1), we understand that the very first moments in the dentist-patient relationship are those which counts… and in many cases the tip of your needle is the very first contact. Choosing a high-quality needle gives you the best chance to transform this key moment into one that instills confidence. An independent study, published in 2005 (2,3), performed an electron microscope scan to take a close look at seven commonly used brands of disposable dental needles. It revealed manufacturing defects at the needle point, such as burrs, jagged edges, and blunt points.
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SEPTOJECT
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PAIN CONTROL
Trust is the key This comparative study concluded that among these seven well-known brands “…the best quality was the Septoject needles from Septodont”.
Septodont needles quality in few points:
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When it comes to painless procedures, everything counts, starting with your dental needle. (1) Septodont is the only company manufacturing over 500 million dental cartridges every year (2) Evaluation microscopique des aiguilles dentaires. Diego Espinosa Sanchez and Roberto Espinosa Ferandez. University center of Health Sciences, Guadalajara, Mexico. Le Chirurgien Dentiste de France No. 1206, du 07 avril 2005 (3) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa Ferandez. University center of Health Sciences, Guadalajara, Mexico. The Dentist. January 2007. 66-68
Discover more about Septodont Needles
To view Product Brochure
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MANAGING PAIN FOR YOUR PRACTICE Orders 1300 65 88 22 |
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www.henryschein.com.au
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PAIN CONTROL
THE STA SINGLE TOOTH ANAESTHESIA SYSTEM Q&A - PART 1 WITH DR. EUGENE CASAGRANDE
1. Do we need to use Topical anaesthetics with the STA system?
3. How do we change the cartridge for multi-cartridges use?
It depends on the injection. Topical anaesthetics works well on mucosal tissue, if used properly. When delivering an infiltration or a mandibular nerve block, I would use a topical anaesthetic by placing the topical on the mucosal tissue at the site of the needle puncture and then waiting for at least a minute before piercing the tissue. However, topical anaesthetic does not work well on the dense tissue of the palate, so the STA pre-puncture technique is useful for piercing the palatal tissue comfortably when performing the AMSA and P-ASA injections. Topical anaesthetic is not needed for single tooth injection or crestal technique.
After dispensing the first cartridge during a mandibular block injection, the needle can be held at the injection site; the dental assistant takes out the spent cartridge from the cartridge holder and loads a new cartridge into the cartridge holder; before placing the next cartridge onto the top of the STA system, the Multicartridge Button should be activated. This will cause the instrument to omit the purge cycle, which forces air out of the micro-tubing and fills it with anaesthetic and will allow the next cartridge to be administered without removing the needle from the injection site.
2. Can you bend the tip when injecting? The needle can be bent from the hub just slightly (5-10 degrees) towards the needle bevel when delivering a single tooth injection on mandibular teeth. This is useful to achieve better access and to determine where the bevel is, since the needle bevel should be placed towards the tooth during this injection. This is the only situation that I would recommend bending the needle.
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4. How deep is the needle inserted? This depends on the injection. The proper and appropriate needle length should always be used; and in any injection the needle should never be inserted deep enough to reach the hub of the needle. For the traditional infiltration and mandibular block injections the STA needle is inserted into the tissue as deep as with the dental syringe – to the injection site. Generally, for the STA injections, the needle should be inserted deep enough to reach the injection site. For the AMSA, the needle is inserted through the palatal tissue until the palatal bone is reached. For the P-ASA, the needle is inserted through the palatal tissue and into the nasal-palatine canal no deeper than approximately
PAIN CONTROL
one half of the 30 ga. ½ inch needle. For the single tooth injection, the needle is inserted into the tooth’s sulcus until resistance is met, which should be the bottom of the sulcus and the top of the periodontal ligament space. For the crestal injection on an edentulous area, the needle is inserted through the crestal gingival tissue until the bone is met.
5. What is the Bi-rotational technique & when do we need to use it? When performing a mandibular block (IA) injection with a dental syringe, all needles will deflect away from the needle bevel as the needle penetrates the tissue to the injection site due the use of mono-bevel needles. This has been shown to be 5-7 mm and is why it takes so long to achieve successful anaesthesia with this injection. Using the STA system handpiece and rotating it 180 degrees as the needle penetrates the tissue to the injection site, needle deflection is cancelled, and the needle goes straight to the injection site. Using the STA for a mandibular block injection has proven to be more successful; produces faster onset of anaesthesia and is less painful in children.
View Dental Education Hub
6. Any tips for new users? Before initial use, the STA system requires operator and staff training on Setup, Operation, Features, Maintenance, and injection techniques. This training is provided by Henry Schein and is useful so that the operator and staff are knowledgeable and confident before the first injection on a patient. When performing the STA injections, the best advice is to always use a 30 gauge Short (1/2“needle), always use the STA Mode of one drop every two seconds; and never use excessive pressure on the needle. More useful information, including important injection videos, is available on the manufacturer’s website: milestonescientific.com/dental-solutions & Henry Schein Dental Education Hub and should be reviewed: dentaleducationhub.com.au/?s=Wand+STA Author
Dr. Eugene R. Casagrande has practiced Cosmetic and Restorative Dentistry for over 30 years in Los Angeles. As the Director of International & Professional Relations for Milestone Scientific for over 23 years, he has published multiple articles and has lectured both nationally and internationally at over 100 dental schools and in over 50 countries on Computer-Controlled Local Anaesthesia
DR EUGENE R. CASAGRANDE DDS, FACD, FICD
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PREVENTATIVE
CARIES MANAGEMENT IN DENTISTRY
Fluoride is the cornerstone of caries prevention. It can be provided in two ways; topically and systemically. Topical application includes toothpastes, mouthwash, and that applied by professionals, while systemic refers to water fluoridation and once upon a time supplement in the form of tablets or drops. With the numerous sources of fluoride and methods of application for at home and professional use, what methods should be used? The following provides a short introduction to options for caries management.
Topical fluoride; foam vs gel vs varnish
Water fluoridation
It is common to include a fluoride treatment as part of a preventative care appointment. But are you doing this because it is indicated or because it is just a well ingrained part of the preventive appointment; first you scale, then you apply fluoride?
Water fluoridation is considered one of the ten greatest public health achievements of the 20th century. A community-wide initiative, water fluoridation aims to deliver fluoride and prevent tooth decay, with around 89% of the Australian population now with access to fluoridated water. The National Health and Medical Research Council report water fluoridation reduces tooth decay by 26% to 44% in children and adolescents, and by 27% in adults. In addition, Australian research has shown that access to fluoridated water from an early age is associated with less tooth decay in adults.3
There are three main options for applying fluoride clinically: varnish, gel, and foam. One great resource to guide your decision making is the Australian Fluoride Guidelines. These Guidelines were first created in 2006 and the third and latest reiteration was developed by consensus in 2019. They provide summarised evidence to support different methods of delivery for fluoride. So, what do they say? The Guidelines report that there is no evidence to support the use of fluoride foam,1.2 while evidence does support the use of fluoride gels and varnishes. Gels, however, are not indicated for children under age 10 due to concerns around accidental ingestion.2 Fluoride gels and varnishes have a high concentration of fluoride and are a vehicle for caries prevention for patients deemed to be at an elevated risk. As part of preventive care, it is important to consider each patient’s risk of caries, whether a fluoride treatment is indicated and the method to deliver it.
Silver fluoride Silver diamine fluoride (SDF) is an effective cariostatic agent for use on coronal and root caries. It can also be used to desensitize hypersensitive teeth. SDF use is simple, painless, non-invasive, and inexpensive; however, the aesthetics may cause concern for some individuals as caries turn black following treatment. SDF is an option for non-surgical management of caries when patient co-operation is limited, such as with young children, or when surgical management is not an option.
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There are patients who query whether they should take fluoride supplements as their drinking water, often bore or tank, is not fluoridated. These patients may reference using these supplements as children and ask whether they should do the same for theirs. The consensus recommendation as part of the Australian Fluoride Guidelines is that these supplements are not recommended. As it is, other than under prescription from a compounding pharmacy, fluoride supplements in the form of drops or tablets cannot be purchased in Australia. For children without access to fluoridated water, together with a caries risk assessment, you may wish to consider some variations to their oral care routine to increase their protection, such as commencement of toothpaste use at a younger age, earlier commencement of standard adult strength toothpaste for children under 6 years or high-strength fluoride paste in older patients. There are options to add in remineralizing creams and mouthwashes, however patient compliance should be considered when suggesting adding creams, mouthwashes and more into routines, when data shows that 1 in 5 adults are still only brushing once daily.4 It is also essential to reiterate the importance of routine examinations and a diet low in free sugars.
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Bio:
Dr Michael Foley wrote a great article for the Australian Dental Association’s consumer oral health website teeth.org.au, titled I cannot access fluoridated water. Should I add fluoride to my own water?. This is a great link for patients.
Dr Mikaela Chinotti, BDS, MPH, graduated as part of the James Cook University inaugural dentistry cohort. She has previously worked in rural and regional government, private and health fund owned practices in North Queensland. Her passion lies in minimal intervention dentistry, health promotion and health education. Now in Sydney, Mikaela works as the Australian Dental Association (ADA) Oral Health Promoter and part time as a general dentist. Mikaela is a founding member of the Colgate Advocates for Oral Health: Editorial Community. She became a member because of her interest in helping and collaborating with fellow dental colleagues and hopes to contribute useful information for young dentists as they start and continue through their careers
Fluoride toothpaste Fluoride toothpaste is well supported by decades of evidence regarding its efficacy in caries prevention. However, in recent years there has been an increase in toothpastes with ingredients other than fluoride added for the purpose of caries prevention. It is important for messaging to remain consistent as advertising those without fluoride as ‘safer’ or ‘non-toxic’ may increase consumer confusion about fluoride. It also contributes to the mass of misinformation, particularly online.
Fluoride vs hydroxyapatite toothpaste
References:
A study of 32 adults reported 10% hydroxyapatite (HA) toothpaste was comparable to 500 ppm fluoride toothpaste in promoting remineralization and inhibiting caries development.5 Although promising, current evidence on hydroxyapatite toothpaste is largely based on small, short term or in vitro studies. Patients with moderate or high caries risk are best to continue with fluoride toothpaste that is well-supported by research until more hydroxyapatite research is released, as further research on the effectiveness of hydroxyapatite toothpaste in comparison to fluoride for caries prevention is still required.
1. Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144:1279–91. 2. Do L. Guidelines for use of fluorides in Australia: update 2019. ADJ 2020;65:30-38. 3. National Health and Medical Research Council. NHMRC Public Statement 2017 Water fluoridation and human health in Australia. 2017. Available at https://www.nhmrc.gov.au/sites/default/files/documents/ reports/fluoridation-public-statement.pdf 4.ADA Consumer Survey. 5. Amaechi BT, AbdulAzees PA, Alshareif DO et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open 2019;5:18.
View the Colgate Advocates for Oral Health articles DR MIKAELA CHINOTTI BDS, MPH 30 March 2022
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PREVENTATIVE
CONSIDERING TOOTHPASTE INGREDIENTS
As dental practitioners, we commonly face the question, what toothpaste should I use? It’s tricky out there for consumers with the vast number of pastes available on the market these days; you have no doubt seen people standing in the supermarket aisle staring blankly at the oral health products available. Consumers also seem to be becoming more invested in the ingredients within their health and beauty products, with many wanting to use a product with ‘natural’ ingredients. It is great that consumers are taking an interest in the products they use to care for their health, except where the toothpaste they choose may not contain ingredients known to mitigate the risk of tooth decay, i.e., fluoride. If people choose to not use toothpaste containing fluoride, it is important that they understand the risks this can pose to their oral health, particularly if other caries-contributing factors, such as free sugar intake, are not controlled. Unfortunately, some brands use marketing tactics to sway consumers to choose fluoride-free products by marketing their ingredients as ‘safer’ alternatives, despite fluoride being proven safe when used appropriately. The sale of fluoride-free toothpastes is on the rise, and this is something to be aware of amongst the dental profession.
However, it is important to understand the context of this scale; it was developed by the American Dental Association who advise that RDA is used by [dental] industry, researchers, or standards organisations to develop new products or to conduct quality control. It should not be used to rank the safety of dentifrices.
Toothpastes may include sodium fluoride, sodium monofluorophosphate, and stannous fluoride with the fluoride concentration labelled as parts per million or weight per volume, or not declared at all, on the tube. Since there is a variation in the labelling of pastes, it is important to be clear with patients when making toothpaste recommendations based on fluoride content. It may not be enough to just casually say, ‘make sure your toothpaste has *this amount* of fluoride’, patients may become confused when they take your advice, but then look to compare products, potentially in search of a lower priced product. You may need to be quite specific in your recommendation.
As well as an interest in ingredients, the ability to recycle household products is of importance to some consumers, with this possibly set to increase as we continue to take focus on environmental issues such as climate change. Although recyclable products are only part of sustainability, it can no doubt influence consumer purchases. Excitingly, Colgate-Palmolive released a range of toothpastes with recyclable tubes in 2021. These are the first of their kind! Additionally, Colgate is sharing this technology with all other companies - they believe it’s that important. They state “it is not about us, it’s about something bigger. By sharing our technology hopefully, we can initiate a global shift to recyclable toothpaste tubes. Our dream is to have all tubes (not just toothpaste) be recycled in practice and at scale”.
When enquiring about toothpaste, some patients may have concerns about abrasivity, especially if they have done research online and come across the table of toothpastes and their respective relative dentine abrasivity (RDA), created by the American Dental Association. This can certainly cause concern for a consumer looking at the table and seeing that their toothpaste is sitting at the higher end of the scale.
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It is important to not label ingredients as ‘good’ or ‘bad’ for patients but acknowledge that there are some ingredients that have the ability, for example, to cause mucosal hypersensitivity or irritation. Sodium lauryl sulphate (SLS), a common surfactant, is added to generate foam during brushing, which helps to wet the tooth surface, disperse the product in the mouth and loosen debris and plaque. However, SLS is a known irritant and has allergenic potential, although a reaction is rare. As a dental practitioner, it is great to know of some SLS-free toothpastes to be able to provide as suggestions to patients.
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For non-recyclable toothpaste tubes, TerraCycle has a recycling program in Australia where consumers can drop off used dental products at specified locations. TerraCycle recycles these products to create items such as play equipment and park benches; this program is supported by Colgate-Palmolive. This is only a taste of what there is to know about toothpastes. For consumers looking for information on toothpaste ingredients and their purposes, an article, Understanding toothpaste can be found on the Australian Dental Association’s new consumer oral health website, teeth.org.au. This has been written to provide consumers with information to help them understand the purpose of different ingredients and is a great resource to refer patients to.
Bio Dr Mikaela Chinotti, BDS, MPH, is a practicing general dentist, having graduated as part of the inaugural dentistry cohort from James Cook University (JCU) in 2013. Mikaela returned to her alma mater completing a Masters in Public Health, majoring in health promotion. Mikaela works at the Australian Dental Association (ADA) as the Oral Health Promoter. Her passions lie in minimal intervention dentistry, health promotion and health education as well as the provision of ethical and equal oral health care for all Australians. Mikaela is an inaugural member of Colgate’s Advocates for Oral Health: Editorial Community; becoming a member due to her strong interest in mentorship, education and promoting good oral health.
View the Colgate Advocates for Oral Health articles DR MIKAELA CHINOTTI BDS, MPH 20 JANUARY 2022
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PREVENTATIVE
DRY MOUTH GEL PROVIDING COMFORT AND RELIEF FOR DRY MOUTH PATIENTS
GC Dry Mouth Gel is a clear gel that provides oral comfort and lubrication by moistening and lubricating the mouth, tongue, and throat. It has a pleasant taste and forms a long-lasting layer which protects the delicate oral tissues. GC Dry Mouth Gel is used to provide comfort and relief for dry mouth conditions, to provide a protective coating for teeth and oral tissue, and to help control bad breath.
Initial presentation, patient suffering from Sjogren’s Syndrome.
Dry Mouth Gel applied three or four times, every day on an ongoing basis
The use of both GC Dry Mouth Gel and GC Tooth Mousse or GC Dry Mouth Gel and GC Tooth Mousse Plus may benefit someone with impaired salivary flow. GC Dry Mouth Gel soothes the symptoms of oral dryness providing lubrication and comfort. GC Tooth Mousse and GC Tooth Mousse Plus provide additional protection to teeth.
Initial presentation
2 week review, Dry Mouth Gel applied daily
Clinical images courtesy of Prof Ian Meyers, Brisbane
To achieve and maintain a healthy oral environment, dry mouth sufferers need your guidance and a home care plan.
Relief FROM DRY MOUTH
To download your Patient Information brochure CLICK HERE
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PREVENTATIVE
USING GC TOOTH MOUSSE FOR COMMON CLINICAL PROBLEMS
GC Tooth Mousse (TM) and Tooth Mousse Plus (TMP) are amongst the most well researched dental products today, with an evidence base of over 150 journal papers and 7 systematic reviews. This article summarises the most common applications that involve daily use of these products, applied with a clean finger or brush onto the teeth just before bed. For infants and young children, TM reduces colonisation of the mouth by cariogenic Streptococcus mutans bacteria, with a corresponding rise in health-associated oral bacteria such as Strep. sanguinis and Strep. salivarius, and lowered acid production by dental plaque. TM increases mineral levels in primary teeth affected by molar-incisor hypomineralisation, or developmental defects of enamel.
Tooth Mousse is highly effective for treating sensitive exposed cervical dentine, by laying down an acidresistant layer of mineral, even in patients with poor salivary flow or gastric reflux. In tooth wear cases, TMP will remineralise tooth structure substrate prior to bonding adhesive materials. In patients having home bleaching using peroxide gels, TMP will treat tooth sensitivity from exposed root surfaces. It will also cause an enamel lightening effect which reduces the yellow colour of teeth.
In patients undergoing orthodontic treatment, TMP is more effective for preventing the development of enamel lesions around brackets than conventional fluoride products. It is highly effective for reversing active white lesions in orthodontic patients.
In older patients, TM and TMP will arrest lesions of root surface caries where the root surface has softened but not yet cavitated. They can also be applied in a smear on overdentures and partial dentures to help protect abutment teeth from caries. Local application of TMP onto glass ionomer cement restorations that contain CPP-ACP (e.g. Fuji VII EP) will recharge the reservoir of these materials so that they can continue to release bio-available calcium, phosphate and fluoride ions.
For high caries risk adults, both active and arrested enamel carious lesions can be reversed. Arrested lesions require a pre-treatment (such as short acid etch) to enhance porosity. Likewise, developmental enamel defects and fluorosis in permanent teeth can be reversed back to a normal appearance. For fluorosis, a longer acid etch pre-treatment (2 minutes with agitation) is needed, with enamel microabrasion to remove surface stains and enhance penetration.
Mild Fluorosis – Before
Long term daily application of TM and TMP can also reduce the likelihood of patients with dry mouth developing tooth wear or dental caries, but combined chemical actions and biological (prebiotic) effects.
Mild Fluorosis – After
Enamel defects – Before
Enamel defects – After
EMERITUS PROF LAURIE WALSH Brisbane, Queensland
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PREVENTATIVE
HOW TO ATTRACT, GROW AND RETAIN YOUR PATIENTS IN 2022
Dr Tony Saad, owner and lead dentist at Dental Avenue Maroubra and Dental Avenue Parramatta talks with Henry Schein NSW Sales Manager, Rushan Dissanayake, on how Guided Biofilm Therapy (GBT) has maximised his revenues and efficiencies. Six months was all Dr Saad needed to start earning money on his investment. Learn how you can calculate a return with GBT immediately and continue to do so year after year.
Rushan Dissanayake: Guided Biofilm Therapy is
rapidly growing around the world as clinicians see the power that GBT has to grow their businesses. Can you tell me a little more about what GBT is?
Dr Tony Saad: If you don’t yet know about GBT,
you must be living under a rock. GBT is truly a game changer for prevention and maintenance in the dental practice. In a nutshell, GBT denotes a method of biofilm management using AIRFLOW®, PERIOFLOW® and PIEZON® technologies in the least abrasive, most efficient and most comfortable method achievable. Clinicians traditionally debride biofilm and calculus simultaneously using repetitive, overlapping strokes followed by polishing pastes. GBT is a systematic, predictable method of biofilm management featuring the intentional removal of biofilm above and below the gumline using minimally invasive powder prior to the removal of calcified deposits. Since we’re removing biofilm early in the appointment, total debridement time is less, which allows extra time for additional services and patient education.
Rushan Dissanayake: Patient education is a big part of GBT. How is this so?
Dr Tony Saad: Disclosing is an important step of
a GBT appointment. It gets the patients engaged. Patients learn why oral care is so important, what happens in their mouth, how they can clean and better manage their teeth and gums at home. With GBT the dental hygiene appointment is more personalised. As a result, patients come back to their recall visits, very excited to see whether their oral care has improved since their prior appointment. Pre-GBT, it was much harder to achieve recall as patients were less motivated as they had less knowledge about their
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oral care. With GBT, it’s much easier and profitable to get patients into a recall system. We also ensure all our team are across our recall system – everyone from our nurses to our front office staff received a GBT treatment so they know how to explain it to customers, the passion that they feel for GBT, gets our patients excited as well. Having the team come together, regularly reviewing our interactions with customers, ensure that our recall system works successfully.
Rushan Dissanayake: How were you first introduced to GBT?
Dr Tony Saad: In 2019 when my lead hygienist,
Kimiko, first trialled GBT, it blew her mind. Clinically it didn’t take too much time to convince me. However, being a businessman, I asked her how do we recover the cost for it? We started considering a couple of ways to cover the costs including modifying our patient billing, itemising our procedures as we realised that we weren’t itemising all our treatments and putting in place a monthly reporting system such as measuring recall percentages, income generated, new patients’ percentage and their source of referral etc. We ordered a GBT machine for each clinic in the first instance and set up a thorough hygiene KPI program.
Rushan Dissanayake: What were the initial KPIs and how are these KPIs tracking now?
Dr Tony Saad: The targets we put in place were
about ensuring we were covering all the costs involved when implementing GBT, this includes the capital equipment cost, on-going consumable costs and annual service costs. The targets we set out were, increasing the number of new patients attending the practice yearly by 30%, increasing the percentage of patient referrals to 50% of total source of referrals yearly, increasing the number of cleans done per year by 50%, increasing chair utilisation to a minimum of 85% per clinician and achieving a ROI on the GBT Machine of no less than 30%.
Rushan Dissanayake: Did you face any challenges during the implantation?
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Dr Tony Saad: As you know, it’s not always rainbows
Rushan Dissanayake: With the challenges that were
and butterflies in a dental surgery. We had challenges but it was a very small price to play to put in place the best prevention and maintenance program our practice has ever seen. We had to introduce a brandnew system to patients. Patients had been so used to our scaling, polishing and fluoride system but the machine speaks for itself. Once patients experienced GBT, they were easily convinced that there was no better way to clean their teeth.
experienced with COVID lockdowns, were you able to generate a positive ROI?
Dr Tony Saad: We looked at the tangible costs of
implementing GBT and how that relates to the value GBT brings our practice and over the initial 6-month introduction period of GBT in 2019, our ROI was 23%. The ROI was positive, meaning the investment was already covering the cost of having the GBT Machine in the practice and contributing to the profits in the practice, after only 6 months!
Rushan Dissanayake: What has been the patient feedback since implementing GBT?
Then looking over the period 2020 and 2021 (during two large interruptions in the practice due to COVID lockdowns in both years), the ROI was a positive 32.37%. As a result, it was a very positive outcome for us.
Dr Tony Saad: The general feedback from customers is that there was a significant improvement in their comfort especially patients with hypersensitivity, patients with periodontal pockets, extrinsic staining or root sensitivity. Patient satisfaction improved as the end results were shiny white clean healthy teeth in a much more comfortable appointment. Patients also feel they are getting more value for their money as they appreciate the additional care that’s being provided and since the appointment is personalised, they are engaged and don’t feel as though they are being lectured to. Since patients are more engaged, they are more motivated to keep their teeth clean, so we’ve noticed a massive improvement in patient oral hygiene and a noticeable decrease in extrinsic staining.
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Rushan Dissanayake: Besides the positive
return on investment, were your other initial targets achieved?
Dr Tony Saad: The targets we achieved were quite
impressive. We found that patients were making more recall appointments, and these were being made immediately so we spent a great deal less time following up. Patients were also booking 2 appointments, booking their hygiene follow up and an appointment for fillings/implants or whitening. So, we have had an increase in the overall practice turnover and profitability – this has been attributable to the hygiene departments.
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PREVENTATIVE
We have had an increase in the number of new patients attending the practice by over 30% and a huge increase in the number of cleans done yearly by 50%. That’s a staggering figure given that we’d effectively lost 3 months’ worth of hygiene appointments due to COVID in both years. checked and double checked those figures and I’m just amazed at the outcome. In addition, we had an increase in the percentage of patient referrals by 100%. Patients referring patients more than doubled in the last 2 years. That’s one of the greatest compliments you can have as a clinician, when a patient refers a friend or family member because they declare the work you have done is special and worth sharing. The practice team have also never worked better. The outcomes and results we have achieved were not achieved by the clinicians alone, it was a group team effort. All team members work together to support the practice and support patients to help them understand the benefits of regular appointments.
It’s amazing how GBT has improved our systems and getting our whole team on board has been a huge win. GBT has impacted our practice in a positive way, and I’m convinced it will for you too. Check out Dr. Tony Saad’s webinar on Dental Education Hub: dentaleducationhub.com.au To learn more about GBT and book a free trial in your practice visit: professional.airflowdentalspa.com.au
Dr. Tony Saad
Rushan Dissanayake: What would you say to
BDS from Sydney University in 1992. For many years he has owned and operated several successful dental practices located in Sydney.
Dr Tony Saad: Do it. Growth in our hygiene
Holds a Master of Business Administration (MBA) at the Australian Graduate School of Management (AGSM), 2003.
clinicians who haven’t implemented GBT?
department has surpassed the ability of our existing GBT Machines so we have now purchased another unit for each practice as we had clinicians all vying for access to the GBT Machines. Patients request GBT and when our device may be out of action for an annual service, patients will rebook their appointments as they don’t want to have the ‘old clean’.
DR TONY SAAD MBA, AGSM Owner and lead dentist at Dental Avenue Maroubra and Dental Avenue Parramatta
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A return of investment can be easily achieved and quickly and believe me, I have included every possible cost including servicing and O-rings. However, whilst measuring ROI is an indication of success in cost recovery, make sure you always look at the big picture. GBT machines can be a self-sufficient investment if you have the systems and targets put in place and these are reviewed and looked at frequently.
Tony consulted to several international dental organisations. This has provided Tony with an array of experiences that range from the new dental product launch in the Australian market to the tailoring of specific in practice protocols.
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PREVENTATIVE
GINGIVITIS REDUCTION & PLAQUE REMOVAL SONICARE DIAMOND CLEAN VS MANUAL TOOTHBRUSH
Objectives To evaluate the ability of the Sonicare DiamondClean to reduce gingivitis and gingival bleeding versus a manual toothbrush over time.To compare the plaque removal ability of the Sonicare DiamondClean to a manual toothbrush over time.
Methodology One hundred forty-two healthy adults aged 18-64 years participated in a single-blind, randomized, parallel group clinical study assessing gingivitis and Gingival Health plaque over time for the Sonicare DiamondClean in vivo study and an ADA reference manual toothbrush. Eligible were routine manual toothbrush Comparison of subjects gingivitis users with a minimum Turesky Quigley-Hein Plaque reduction Index andofplaque removal by –>1.8 presented following three to six hours Sonicare DiamondClean a least 20 sites graded plaque accumulation,and with at –>1 by the Modified Gingival Index. Eligible subjects manual toothbrush Delaurenti M, et al. An Evaluation of Two Toothbrushesand on Plaque and Gingivitis. Journal were randomized trained on product usage of Dental Research. 2012, 91(Special Issue B):522.. twice daily. Subjects retained the assigned product for four weeks. Efficacy and safety evaluations The Sonicare DiamondClean was significantly superior to a manual toothbrush in overall percent plaque and fourgingivitis and occurred at Weeks 2 reduction and 4,over intwo which mondClean to reduce weeks (p<0.0001). anual toothbrush plaque levels were reassessed.
he Sonicare r time.
d 18-64 years parallel group clinical time for the Sonicare ual toothbrush. Eligible sers with a minimum presented following h at least 20 sites Eligible subjects were twice daily. Subjects ks. Efficacy and safety which gingivitis and
The Sonicare DiamondClean was superior to a manual toothbrush in plaque reduction in all sub-regions of the mouth over two and four weeks (p<0.0001).
Results The Sonicare DiamondClean showed significant Conclusion reduction from baseline in gingivitis after two and four Sonicare DiamondClean was demonstrated to be up to weeks product (p<0.0001). two timesof more effective at use reducing gingivitis and gingival bleeding relative to a manual toothbrush, and up to five times more effective at removing plaque. Both products were safe for use.
The Sonicare DiamondClean showed significant reduction from baseline in the number of sites with gingival bleeding over two and four weeks (p< 0.0001). The Sonicare DiamondClean was significantly superior to a manual toothbrush in reducing gingivitis and the number of sites with gingival bleeding over two and four weeks (p<0.0001). The Sonicare DiamondClean showed significant reduction from baseline in plaque after two and four weeks of product use (p<0.0001). The Sonicare DiamondClean was significantly superior to a manual toothbrush in overall percent plaque reduction over two and four weeks (p<0.0001). The Sonicare DiamondClean was superior to a manual toothbrush in plaque reduction in all sub-regions of the mouth over two and four weeks (p<0.0001). Both restorations were finished and polished with the shine derived from the use of Comprepol Plus before Composhine Plus rotary polishers with the ease of luster and polishability evident in the final result. Conclusion Sonicare DiamondClean was demonstrated to be up to two times more effective at reducing gingivitis and gingival bleeding relative to a manual toothbrush, and up to five times more effective at removing plaque. Both products were safe for use.
Percent Reduction in Sites of Gingival Bleeding from Baseline % of Bleeding Reduction
Percent Plaque Reduction from Baseline Overall % of Plaque Reduction 35
57
52
31
31
ficant reduction from al bleeding over two and
ficant reduction weeks of product
61 54
ficant reduction ur weeks of product
tly superior to a manual umber of sites with (p<0.0001).
Percent Gingivitis Reduction from Baseline Overall % of Gingivitis Reduction
8
4 Week 2 Sonicare DiamondClean
17
Week 4 Manual toothbrush
16
Week 2 Sonicare DiamondClean
32
Week 4 Manual toothbrush
Week 2 Sonicare DiamondClean
Week 4 Manual toothbrush
Delaurenti M, et al. An Evaluation of Two Toothbrushes on Plaque and Gingivitis. Journal of Dental Research. 2012, 91(Special Issue B):522..
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ENDODONTICS
EDGEONE FIRE PRODUCT EVALUATION
Heat treated with firewire, NiTi reciprocating files are strong and flexible for efficient and predictable root canal treatment. If you found an affordable endodontic file system that simplified root canal procedures while allowing you to use the same familiar technique, would you give it a try? What if those files were offered at a lower cost but maintained the same or better strength and flexibility as your previous endo files? Would it be worth the switch? DPS evaluator Dr. Abraham Jaskiel is convinced that it is. After testing EdgeEndo’s EdgeOne Fire heat-treated reciprocating files in his practice, Dr. Jaskiel was pleasantly surprised with the “very strong, predictable, and easy-to-use system.” He said he was able to perform endodontic procedures with ease and appreciated that the 4-file system eliminated the need for multiple files. Designed to shape canals with the same sequence and reciprocating motion as gold-treated files, EdgeOne Fire files are available in 4 sizes (20, 25, 35, and 45) and 3 lengths (21 mm, 25 mm, and 31 mm). Because of the familiar sequence and reciprocating motion, switching from previous files to EdgeOne Fire is seamless, according to the manufacturer. “I find this system better, stronger, and easier to use than other, more expensive systems that I have used in the past,” Dr. Jaskiel concluded. Cutting Efficiency, Progressive Taper, Canal Path Navigation EdgeEndo has “provided reliable files that clean and shape efficiently and effectively,” said Dr. Russ Jensen, who called EdgeOne Fire a predictable and efficient system. “It allows for a streamlined cleaning and shaping process, simplifies endo, and allows us to finish our endodontic procedures more quickly,” he added. “I like the ability to cut efficiently while maintaining flexibility,” Dr. Varo Boyer noted. He said the files helped him navigate tough canals, especially second molars and curved canals, so that he could perform procedures more confidently
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without worry of file separation. Thanks to EdgeOne Fire, Dr. Boyer is now performing root canals that he previously would have referred to an endodontist. “I am more confident in going for the tougher root canal treatments,” he shared. Noting that the files are easy to use, Dr. Nilay Nanavati stated, “Narrow canal navigation was not difficult, and the gutta percha fit exactly to the shape of the canal taper.” Dr. Jeremy Lowell praised the smooth movement of the EdgeOne Fire files and said, “I have been doing root canal therapy for years and these were just as good as other products that I use.” Admitting that he’s not always a fan of progressive taper files, Dr. Jason Wetmore was impressed with EdgeOne Fire files, calling them “fast, highly efficient rotary files that worked well and were not too aggressive.” He concluded, “It’s an excellent product that works as good or better than similar products.” Flexibility and Strength According to EdgeEndo, EdgeOne Fire files are flexible and strong, with 5 times the cyclic fatigue as gold-treated files. Dr. Boyer was pleased that the files did not fracture while shaping difficult canals and called them “extremely flexible yet strong files.” Dr. Wetmore agreed that they are “very flexible, highly efficient files.” Dr. Nanavati said he did not experience any file breakages, and Dr. Todd Sarubin suggested that different size files, perhaps a size 12 or 17, may help access the most difficult canals.
ENDODONTICS
“EdgeEndo’s files productivity.”
have
enhanced
speed
and
Jason Wetmore, DMD Rockledge, FL
“No file breakages, and gutta percha fit exactly to the shape of the canal taper.” Nilay Nanavati, DDS Lindenhurst, NY
“This system is better, stronger, and easier to use than other more expensive systems.” Abraham Jaskiel, DMD Miami, FL
“The system is predictable and efficient, allowing for a streamlined cleaning and shaping process.” Russ Jensen DMD; Boise, ID
Calling them “quality files that don’t separate,” Dr. Eric Winterton said it was easy for him to switch from gold-treated files to EdgeOne Fire. Although he reported no file separations, Dr. Jensen noted, “The files tended to unwind faster than some other files when using on multicanal teeth.” Efficiency of Endo Procedure After performing 6 to 8 root canals a day, Dr. Wetmore concluded that EdgeOne Fire files have enhanced speed and productivity in his practice. In addition, they help cut down on the “high cost of name-brand rotary files.” The files were very straightforward to use on easy root canals, said Dr. Sarubin, but he reported that the more challenging canals required some prep work before switching to the fire wire. “No question, the root canal took less time [than with previous files],” Dr. Sarubin revealed. He also pointed out that EdgeOne Fire offered “good gutta percha fit and tugback, which is crucial to the success of a root canal.”
Takeaways •
Designed to shape canals with the same sequence and reciprocating motion as gold-treated files
•
Available in 4 sizes (20, 25, 35, and 45) and 3 lengths (21 mm, 25 mm, & 31 mm)
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Stronger than gold-treated files with no file breakage
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Flexible to fit narrow, curved canals
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Allow for more efficient, predictable root canal procedures
“I love EdgeEndo products,” declared Dr. Winterton, who said that EdgeOne Fire files “can be used to finish a case in much less time than before.” Calling the files easy to use, Dr. Nanavati agreed that the files worked efficiently and were comparable to his existing system, adding that it was “an easy transition from my existing file.” Dr. Jensen concluded, “These files allowed us to finish our root canal procedures more predictably, more effectively, and in less time.” Overall Satisfaction “I really enjoyed using these files,” noted Dr. Wetmore, who said he plans to add EdgeOne Fire to his current assortment of files. Acknowledging that he will purchase the files in the future, Dr. Sarubin called them “a great adjunct to my armamentarium for root canal therapy.” Perhaps Dr. Jensen summed it up best by saying, “The system is predictable and efficient, allowing for a streamlined cleaning and shaping process.” Article from “Dental Product Shopper” Vol.14 No.5.
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ENDODONTICS
ENDODONTIC CASE REPORT TOOTH #36 I EDGETAPER PLATINUM
Fig 1 First lower, left molar showing a decay on the distal part with the symptom of irreversible pulpitis. Firstly, the decay is removed, and the tooth is built again with a temporary filling. Then the rubber dam is placed, and the access cavity is done. Fig 2-3 Pre-Operative Photograph The four canals were opened using the SX EdgeTaper Platinum. The coronal part was also widened using the S1 EdgeTaper Platinum. Working length and patency are obtained with a #10 K-file. A #15 K-file was used to confirm length and patency. Thanks to the technology of EdgeEndo, I was able to prebend the
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JEAN-CHARLES CAMBRESIER Endodontist & Expert Dentist Gembloux, Belgium
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file for comfortable shaping even if the opening was reduced. S1, S2, F1 and F2 EdgeEndo Platinum were brought to the full length of the canal. Fig 4-8 During the cleaning of the isthmus between the mesial canals, an extra canal showed up. The shaping phase was fast and efficient using SX to the F2. Fig 9-12 The cone fit Xray showed great length and a common exit for two of the three mesial canals. The root filling was done with a single cone technique using the BUSA EndoSequence Bioceramic Sealer. The post op X-Ray shows great density and length of the root filling.
integrated Root ZX apex locator. The Tri Auto ZX2 is the successor to the original Tri Auto ZX cordless endodontic motor and offers easy, intuitive operation with a host of new and unique functions.
ENDODONTICS
Optimum Torque Reverse (OTR) and Optimum Glide Path (OGP) are two of the new safety functions the Tri Auto ZX2 provides. OGP simplifies glide path INGENIOUSLY VERSATILE creation and the OTR function is an intelligent torque reverse that reduces the risk of file fatigue and breakage with a unique motion that is employed when the preset torque limit is reached.
TRI AUTO ZX2
Unique Optimum Torque Reverse (OTR) Optimum Glide Path mode (OPG) The Tri Auto ZX2 is a compact, lightweight, cordless Integrated apex locator endodontic motor with an integrated Root ZX apex Lightweight (140g) locator. The Tri Auto ZX2 is the successor to the Eight programmable memories original Tri Auto ZX cordless endodontic motor and offers easy, intuitive operation withRPM a host of new and Operation speed 100-1,000 unique functions. Eleven torque limit settings (0.2-5.0 Ncm) Optimum Reverse (OTR) and Optimum Glide AdaptableTorque for left or right-handed clinicians Path (OGP) are two of the new safety functions the Tri Auto ZX2 provides. OGP simplifies glide path creation and the OTR function is an intelligent torque reverse that reduces the risk of file fatigue and breakage with a unique motion that is employed when the preset torque limit is reached.
Testimonials
morita.com.au
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Unique Optimum Torque Reverse (OTR)
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Optimum Glide Path mode (OPG)
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Integrated apex locator
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Lightweight (140g)
Dr. Sebastian Riedel, Endodontist Berlin
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Eight programmable memories
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Operation speed 100-1,000 RPM
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Eleven torque limit settings (0.2-5.0 Ncm)
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“The Tri Auto ZX2 with its cordless design and integrated apex locator is unique in its functionality in the surgery. The addition of the new Optimum Torque Reverse (OTR) and Optimum Glide Path (OGP) features ensure safe, conservative preparations are made easier.”
Adaptable for left or right-handed clinicians
“The new Tri Auto ZX2 makes control of the preparation process easier. OGP and OTR: Two decisive, new and innovative functions form a symbiotic relationship of safety and efficiency to alleviate mechanical preparation.”
Dr. Jeff Ward, Endodontist Melbourne
“I can´t do endo treatment without OGP after using Tri Auto ZX2.” Dr. Yoshi Terauchi, Endodontist Tokyo
Thinking ahead. Focused on life.
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ENDODONTICS
HYFLEX EDM CASE REPORT HARDNESS TESTING IN ROOT CANAL WITH EXTREME CURVATURE
Diagnosis
User benefits
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Patient with pain in tooth 26 and deep distal carious defect.
Due to the innovative manufacturing process HyFlex EDM NiTi files have a controlled memory and are extremely flexible and fracture resistant.
Challenge
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Preparation of a strongly curved canal profile with curvature ofnearly 90 degrees.
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Treatment
• • • •
Opening of the pulp. Preparation with the universal EDM file in ISO size 25. Apical enlargement with a 40/.04 file and 50/.04 palatal. Obturation with gutta percha and GuttaFlow 2.
Safe and efficient preparation of strongly curved roots canals
Fast and reliable results using a reduced number of files Preparation with just one universal EDM file in ISO size 25 is totally sufficient.
•
Safe operation due to centered canal preparation Controlled memory effect, allowing optimal preparation in the center of the canal.
Conclusion HyFlex EDM Files are ideally suited for simple and efficient preparation of strongly curved root canals with a reduced number of files. The EDM manufacturing process produces files that are extremely fracture resistant and flexible. Due to the controlled memory effect, HyFlex Files are pre-bendable and do not bounce back
“In this case, the filigree endo-instruments could clearly demonstrate their true break-proof qualities. It was possible to clean the canal in only a few minutes. Even in such extremely curved root canals, no additional equipment was necessary and the preparation could be performed using standard instruments and without greater risk.” Dr. Thomas Rieger
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To view the Hyflex Range on our website
Hyflex File System Hands-on Course NSW/ACT only
CLICK HERE
CLICK HERE
ENDODONTICS
BIODENTINE TESTIMONIAL BIOACTIVE DENTINE SUBSTITUTE
Biodentine is a material that I have been using for the past 7 years. I have frequently used it in instances where there are carious lesions extending to the pulp. When there is a vital pulp exposure due to caries, I have placed Biodentine as a direct pulp cap and have observed a good response from the tooth whereas these teeth would have been routinely ending up with a root canal treatment. I have also routinely used it as an indirect pulp cap to achieve a similar result. The rate of success is such that I have been able to prevent a tooth ending up having a root canal in at least half of my cases with deep caries exposures. Having researched materials that are biocompatible for pulp exposures, I have routinely used other remedies but when Biodentine was introduced, I do have a higher rate of success of pulpal healing. I will recommend dentists to try this material as an option instead of directly sentencing a tooth to a root canal treatment especially if there is good blood supply to the pulp. Most patients are happy to try this option with the caveat that there may be a possibility of a root canal treatment if pulpal healing does not occur.
Always ensure that haemostasis has been achieved before placing into the cavity. I then routinely cover Biodentine with a GIC to reduce the fast wearing of the material. I will then restore the tooth permanently once symptoms of sensitivity and pain disappears with Biodentine left in situ close to the pulpal region as a base. In summary, Biodentine is a material that gives an option for the possibility of preventing a root canal treatment and most patients are happy to have this option. DR HAMENT HARI BDS WA, Australia
The drawback of this material is that it is very technique sensitive. If the mixing time and ratio of liquid to powder is not properly done, the material is not effective. I would recommend waiting at least a minute or two after mixing as the material then gets to a consistency of cavit, which is then easier to place into a cavity.
Watch Biodentine mixing instructions
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PROSTHETICS
BRILLIANT CRIOS A PURE COMPOSITE
To date, its use for the indication of tooth-coloured restorations in the anterior and posterior tooth regions has been determined by the material properties of the restoration material selected. For all-ceramic restorations, restricted vertical clearance and bruxism in particular caused problems. In the aesthetic region, too much tooth substance was often sacrificed (Fig. 1). In addition, the bond between the luting composite and the ceramic was a weak point, which often resulted in fractures of the marginal ridge under heavy loading (Fig. 2). In most cases, a demarcation line was apparent due to the different light refraction of the materials in the marginal area. On the other hand, the use of composite as a CAD/CAM or restoration material offers a range of benefits. Here, no luting gap develops but instead there is a mono-phase due to the homogeneous bond between the workpiece and the luting composite. This in turn leads to a good transitional effect and natural aesthetics. The high flexural strength and the tooth-like modulus of elasticity create a resistant restoration with a shock-absorbing effect, which is particularly positive for bruxism (Fig. 3). These are all properties that can be found in BRILLIANT Crios, a pure composite. To satisfy the most stringent aesthetic demands, the material is available in 9 Low Translucent and 4 High Translucent shades. In the following, the procedure for using CAD/CAM composite is explained using several application cases:
Fig. 1: Teeth ground excessively
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Case 1 After visual impression taking, the cavity is covered with a moist cellulose swab to prevent the tooth drying out and thus any possible postoperative issues. Then the inlay was designed and, in this case, the BRILLIANT Crios material was selected for the milling process. The resistance of the material is already apparent after the milling process because the sprue still retains the inlay (Fig. 1) – a ceramic restoration would have broken off here. For the subsequent procedure of adhesive luting, the proximal region is isolated with a sectional matrix and adaptively stabilised with a wedge beforehand. Due to the high enamel content of the cavity, the total etch technique is used, whereby the enamel is etched with phosphoric acid for 30 seconds and the dentine for 15 seconds (Fig. 2). Then the etching gel is sprayed for a good 30 seconds to remove the dissolved precipitates and at the same time to neutralise the acidic pH environment of the tooth. In the next step the cavity is dried with oil-free air and the etching pattern is checked. For the following steps up to the definitive luting, the operating lamp is switched off. The adhesive ONE COAT 7 UNIVERSAL (COLTENE) is used as bonding agent and rubbed in for 20 seconds (Fig. 3). A gentle stream of air is applied to prevent the formation of puddles or too thick a bond layer. Pre-curing the bond in the cavity is mandatory
Fig. 2: Ceramic margin fracture
Fig. 3: Graphic representation of the flexural strength
PROSTHETICS and is performed for 10 seconds with > 1000 mW/ cm2 (Fig. 4). On the side of the workpiece, the luting surface is sandblasted with 50 μm aluminium oxide (Al2O3) and cleaned with pure alcohol but not etched. To obtain an optimal bond between the materials, according to the manufacturer’s luting protocol the subsequent application of the ONE COAT 7 UNIVERSAL adhesive to the luting surface of the workpiece is essential. The bond is rubbed into the surface for 20 seconds and then air blown (Fig. 5). To ensure a close fit, no light polymerization is performed at this point. Final curing is subsequently performed through the restoration. Applying silane solution is neither necessary nor useful as BRILLIANT Crios is a pure composite. For the cementing of inlays, overlays or a full crown, either a dual-curing, composite-based cement or a normal restoration composite can be used.
As the workpiece in this case is made of composite and has a considerably reduced grinding resistance compared to ceramic, the processing of the margins can be started immediately with an 8-μm diamond polisher. Likewise, the excess can be easily finished back proximally without leaving any residue, using an oscillating file, for example, because the surface hardnesses do not vary. For occlusal adjustment, a pre-polishing agent such as Comprepol Plus and for high-gloss polishing depending on the anatomy Composhine Plus tips or the ShapeGuard wheel (DIATECH) can be used. Immediately after completing the restoration, the composite inlay is integrated perfectly into the remaining tooth structure (Fig. 6). As the restoration is made of composite, individual characterisation can also be performed if required. For this purpose, the fissures in non-load bearing areas can be ground away with a pointed 40-μm diamond instrument and sandblasted. After cleaning with alcohol, these areas are again wetted with ONE COAT 7 UNIVERSAL and light cured (Fig.7). This area is then characterised with methacrylatebased stains (Fig. 8). The composite material is particularly suitable in critical cases, such as here in an adolescent with a micro-tooth, since margins are also possible without step preparation (Fig. 9). The margins can be finished substance and gingivafriendly by polishing from the margin to the tooth (Fig. 10).
Light-curing composites such as BRILLIANT EverGlow have a higher optical fade-in effect. The versatility of this submicron material allows application without the use of ultrasound. The restoration composite is adapted to the cavity walls and the inlay is inserted with gentle but steady pressure. As the excess remains on the margin and does not flow off, precise removal and cleaning of the marginal areas is possible without time pressure. After checking the correct processing of the margins, each restoration surface is light cured for at least 30 seconds with > 1000 mW/cm2, starting transdentally buccal and lingual.
Fig. 1: Ground BRILLIANT Crios inlay
Fig. 2: Etching of the cavity
Fig. 3: The ONE COAT 7 UNIVERSAL bonding agent is applied
Fig. 4: Light curing of the bonding agent
Fig. 5: ONE COAT 7 UNIVERSAL bond is applied to the inside of the inlay and then dispersed with air
Fig. 6: Inserted BRILLIANT Crios inlay
Fig. 7: Preparation of the characterisation of a composite restoration
Fig. 8: Characterisation with stains
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Fig. 9: Restoration of a microtooth with BRILLIANT Crios
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Fig. 10: Perfect integration and adaptation of the tapered crown margin
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PROSTHETICS Case 2 The high degree of homogeneity and the possibility of combining dentine and enamel-coloured CAD/ CAM composites also allows the fabrication of implant-supported restorations (Fig. 1). In this case, a base was first prepared with an opaque BRILLIANT Crios block to cover the metal and to condition the gingiva (Fig. 2). Then a second optical impression is taken using a rubber dam
Fig. 1: Placed implant
(Fig. 3) to create a superimposed crown from an enamel-coloured CAD/CAM block (Fig. 4), which is then inserted and characterized according to the applicable rules (Fig. 5). As both parts consist of pure composite, a complete bond is created between them. The tooth-like modulus of elasticity helps to absorb the forces over the implant.
Fig. 2: Covering the titanium base with opaque BRILLIANT Crios
Fig. 4: Adhesive preparation for luting a BRILLIANT Crios pontic
Fig. 3: Optical impression of the abutment design
Fig. 5: Inserted and characterised BRILLIANT Crios Crown
Case 3 It is often difficult to place an implant, or it is simply not desired by the patient. In this case, a minimally invasive pontic can be attached adhesively to an adjacent tooth (Fig. 1).
Fig. 1: Preparation of a pontic in BRILLIANT Crios
The occlusal conditions are taken into consideration here and the pontic is designed from distal to mesial as far as possible (Fig. 2)j
Fig. 2: Inserted pontic
Case 4 If an implant was not possible or desired in the anterior region when the second incisors were not placed, then an all-ceramic adhesive bridge was often used as a solution (Fig. 1). However, as expected, this sometimes leads to a loss of adhesion or to a fatigue fracture (Fig. 2).
Fig. 1: Example of an all-ceramic adhesive bridge
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As the entire front region exhibited defects, the decision was made in favour of a complete restoration with composite. The old restorations were removed, and the missing lateral incisors were replaced by mesially directed BRILLIANT Crios extension bridges (Fig. 3). Subsequently, the front was slightly prepared starting from buccal and the
Fig. 2: Chipping of an all-ceramic bridge
PROSTHETICS composite pontics were conditioned with 50 μm aluminium oxide (Fig. 4). The remaining enamel surfaces were conditioned with phosphoric acid and then everything was prepared for adhesion (Fig. 5). To give the restorations a natural shade impression, some yellow and incisal blue stains were applied and pre-cured in the cervical and central regions (Fig. 6). Subsequently, BRILLIANT COMPONEER
veneers prefabricated with a translucent composite were placed on all tooth units (Fig. 7). As we work exclusively with composite here, everything can be combined with each other which leads to an aesthetic result (Fig. 8). This restoration technique makes it possible to restore anterior aesthetics in just a single session without causing too much trauma.
Fig. 3: Restoration with BRILLIANT Crios extensive bridge
Fig. 4: Preparation of the anterior and conditioning of the composite pontics
Fig. 6: Yellow and blue stains give the restoration a natural impression
Fig. 7: The prefabricated COMPONEER shell is inserted with a translucent BRILLIANT EverGlow composite
Case 5 In the following case, the missing lateral incisors were replaced with an overcontoured partial denture (Figs. 1 and 2). Minimal buccal preparation was performed for occlusal reasons (Fig. 3). At the end, all front teeth were veneered with BRILLIANT COMPONEER and the dental arch was rounded (Fig. 4).
Fig. 1: Existing partial denture
Fig. 8: Completion of the composite restoration
Treatment was performed without anaesthesia and led to complete, fixed and aesthetic rehabilitation (Fig. 5). In conclusion, it can be said that composite restorations need to be handled less restrictively these days and can also be applied more easily and effectively in patients across an extended range of indications.
Fig. 2: The missing lateral incisors are replaced with an overcontoured partial denture
Fig. 4: Veneering of front teeth and BRILLIANT Crios extensions with BRILLIANT COMPONEER
Fig. 5: Etching of the remaining enamel surfaces
Fig. 3: Buccal preparation for a BRILLIANT Crios extensive bridge
Fig. 5: Fixed and aesthetic composite restoration
To view the Brilliant CRIOS on our website CLICK HERE
DR. MED. DENT. MARIO BESEK
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SURGICAL
NEW R.T.R+ BIPHASIC FORMULATION Q&A
1 What is RTR+? RTR+ is the new upgraded range of Septodont bone substitute, replacing RTR syringes by using a biphasic formulations (B-TCP/HA) that allow dental practitioners to choose and manage the pace of their bone graft procedures and support creation of a stable high quality new bone. 2 Is RTR+ fully resorbable, even if containing hydroxyapatite? Yes RTR+ is fully resorbable. Both B-TCP and Hydroxyapatite are 100% resorbable but on different pace. The benefits of RTR+ particularly come from this appropriate balance between both components: •
The fast-acting B-TCP (B-Tricalcium phosphate)
•
The slower resorption HA that provides the right scaffold and hence the high stability
The resorption time is hence slower than RTR but it is your choice, with both formulations, to pick up the one that is most adapted to the clinical situation. 3 Why was HA added? Hydroxyapatite is bringing a slower resorption, hence the right scaffold and therefore the high stability of the new bone formation. RTR+ relies then on the appropriate balance between HA and the fast-acting B-TCP.
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With the possibility to choose between 2 formulations, you can really manage your bone graft procedure and adapt your procedure to the clinical situation. 4 When should I use 80/20 or 40/60? The range allows you to choose the pace of your bone graft procedure. If you require a socket filling with a fast new bone formation to prevent future bone weakness, RTR+ 80/20 might be your preferred choice. If you prefer a longer resorption pace, hence an even more stable new bone formation, then RTR+ 40/60 will certainly be your choice. Obviously, both treatments are of a high quality and allow future implant placement. 5 What is the shelf life of the product? RTR+ has a shelf life of 5 years.
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INSTRUMENTS
CHU’S AESTHETIC GAUGES THE START TO A PERFECT FINISH
Overview Chu’s Aesthetic Gauges are used for quick, accurate measurements during a crown lengthening procedure. Predictable and swift diagnosis and correction can be accomplished with a minimum amount of stress and a maximum amount of patient gratification.
Chu’s Proportion Gauge With color-coded measurements having a predetermined ratio of about 78%, Chu’s Proportion Gauge is the easiest, fastest, and most precise instrument for diagnosing tooth size and proportion discrepancies.
Case Synopsis A 24-year-old African-American female presented with excessive spacing between the maxillary anterior dentition and buccal flaring with distal inclination of the canine teeth. The question was whether a tooth size, arch size, or combination discrepancy existed for this patient. Upon clinical examination, it was clear that the maxillary lateral incisors were developmentally deformed [peg size/shape] which led to the diastema; however, it was uncertain whether the central incisors were within normal limits of individual tooth size and proportion Using Chu’s Aesthetic Gauges, which define ranges of individual tooth size using predefined measurements, tooth and arch size discrepancies can be quickly and easily diagnosed. The maxillary central incisors for this patient were found to be slightly deficient in width. The aesthetic restorative therapy entailed correction of tooth dimensions of all the maxillary anterior teeth using the gauges as a guide for reconstruction of size and shape with ceramic laminate veneers. The centrals were corrected first, then the canines for occlusion, and then the lateral incisors. With Chu’s Aesthetic Gauges, predictable and swift diagnosis and correction can be accomplished with a minimum amount of stress and a maximum amount of patient gratification.
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INSTRUMENTS The Proportion Gauge • • • • •
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Precise color-coded measurements. Provides quick, accurate diagnosis of tooth proportion Provides accurate results and reduces chairside adjustment time Easy to read - reduces visual fatigue Common reference guide between clinicians and labs. Results in effective communication to reduce the incidence of errors, and repeated adjustments. Compatible with IMS® cassettes and can be easily sterilized along with other instruments. Reduces incidence of cross-infection.
T-Bar Tip The T-bar tip has a vertical and horizontal arm. This measures length and width at the same time.
Inline Tip The Inline tip has a short and long vertical arm. This helps to measure the length and width, independently, in cases of crowding where the use of the T-bar tip may be difficult.
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The Crown Lengthening Gauge • • • •
Precise color-coded measurements. Provides quick, accurate measurements and better results Easy to read - reduces visual fatigue Compatible with IMS cassettes and can be easily sterilized along with other instruments. Reduces incidence of cross-infection.
BLPG The BLPG tip has predefined measurements to help achieve the proper mid-facial clinical crown and biologic crown length during a crown lengthening procedure. The Papilla tip has predefined measurements to help establish the correct aesthetic position of the interdental papilla from the incisal edge before the flap is closed and sutured.
Papilla Tip The Papilla tip has predefined measurements to help establish the correct aesthetic position of the interdental papilla from the incisal edge before the flap is closed and sutured.
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After
INSTRUMENTS
The Sounding Gauge • •
Bone sounding made simple and quick. Sounding tip curvature and sharpness allows easy manipulation and access into deeper areas to analyze the level of the bone crest.
Sounding Tip The Sounding tip helps determine the sulcus depth, mid-facial osseous crest location and inter-proximal
Sounding Tip
osseous crest location.
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DR STEPHEN CHU DMD, MSD, CDT, MDT
to view on our website
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INSTRUMENTS
HISTORY OF KEY OPINION LEADERS THEIR INTEGRAL ROLE IN PRODUCT INNOVATION AND DEVELOPMENT
HuFriedyGroup provides the best dental experience to the industry. Their unique combination of products, services, and support enable dental professionals like you to reduce risk, improve efficiencies, drive compliance, and enhance patient and staff safety. HuFriedyGroup has a tradition of collaboration - Key Opinion Leaders have a long history of supporting the development of their instrument product portfolio. More than 60% of their products have been developed in partnership with dental professionals, institutions, or universities. As HuFriedyGroup, our Key Opinion Leader program will continue to strongly impact and influence the way we shape, design and create our product offerings. We place great emphasis on maintaining collaborative relationships between our company and opinion leaders. Our team of artisans, engineers and product specialists encourage our partners to provide input throughout the ideation, research, development and execution processes. We recognize the important role our Key Opinion Leaders play in advancing dentistry and helping HuFriedyGroup continue to be a world leader in dental product innovation.
2004 - Edward Pat Allen - Allen Microsurgical Elevator The tunnel technique, originally known as the pouch technique, was introduced by Raetzke in 1985. The aim was to avoid any kind of releasing incisions, as described by Raetzke, this technique’s main characteristic was the insertion of an autologous connective tissue graft in a pouch that was created in the buccal soft tissues around the exposed root surface by means of a split thickness flap preparation. Favorable aesthetic outcomes, as well as the simplicity of this approach, were the main reasons for its broad acceptance in clinical periodontology.
Since this technique had been originally proposed for single tooth defects only, Allen A. L. demonstrated the use of the pouch technique at multiple adjacent gingival recession defects (Allen, 1994). In 1999 Blanes R. J. and Allen E. P. published a technique which combined a tunnel with lateral pedicle flaps to completely cover a CTG. Afterwards, Edward Patrick Allen introduced a coronally positioned tunnel technique that was difficult to perform with conventional instruments so he partnered with Hu-Friedy in the development of specific microsurgical designs for improving performance. He continues to promote these instruments and his technique worldwide.
ALLEN MICROSURGICAL ELEVATOR PPAELX
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View Dr Pat Allen’s “Protecting the Lower Anterior Sextant with Tissue-Enhancing Techniques”
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INSTRUMENTS
2008 - Stephen Chu - Chu’s Aesthetic Gauges™ Instruments An interdisciplinary team approach to multidisciplinary therapies in esthetic restorative treatment has become commonplace in the dental profession.
Chu’s Aesthetic Gauges™ Instruments can also evaluate clinical and anatomical tooth dimensions and could finalize the treatment through the application of quantitative standards.
However, the perception of dental esthetic varies significantly among dental professionals, although substantial efforts have been made to establish common standards.
Stephen J. Chu is an Adjunct Clinical Professor at New York University College of Dentistry in the departments of periodontology, implant dentistry, and prosthodontics. He maintains a private practice in fixed prosthodontics, esthetic, and implant dentistry in New York City.
Visual precision, without any guesswork or estimation based on emotional considerations are crucial for successful and predictable treatments. For this reason, Chu created instrumentation to diagnose and predictably treat esthetic tooth discrepancies and deformities.
Stephen has contributed over 80 publications including 6 textbooks in the dental literature and has given lectures nationally and internationally on the subjects of esthetic, restorative, and implant dentistry.
CHU’S AESTHETIC GAUGES™ INSTRUMENTS HF-SCHUSET
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Don’t miss Prof Stephen J. Chu, a Keynote speaker at AOSASP2022 Thursday 18 — Saturday 20 August 2022
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INSTRUMENTS
HARMONY ERGONOMIC SCALERS AND CURETTES
It’s no secret that most dental professionals experience fatigue, pain, and discomfort of the hand, wrist, or arm on a daily basis. But since the COVID pandemic surfaced, many dentists and hygienists have been forced to switch from power instruments to hand instruments, which often exacerbates any previous work-related discomfort from repetitive motion. “I was getting pain in my thumb joint from having to mostly hand scale since COVID,” described Deborah Deal, CRDH. Hoping to relieve fatigue and discomfort for clinicians, Hu-Friedy developed an innovative and ergonomic hand-scaling solution, the new Harmony Ergonomic Scalers and Curettes. Combining Hu-Friedy’s proprietary TrueFit technology with its EverEdge 2.0 blade sharpness technology, the Harmony instruments provide an ergonomic solution that reduces a clinician’s pinch force grasp, improves grip, and requires less pressure on the tooth - perhaps extending the length of a dental professional’s career. For Deal, and many other dentists and hygienists who evaluated the Harmony scalers and curettes for DPS, these instruments provide much-needed relief from daily discomfort. “The Harmony design allows me to use a lighter grip to remove deposits, and it is less stressful on my finger joints,” Deal stated. TrueFit Technology & Reduced Hand Fatigue The Harmony ergonomic scalers and curettes are designed with Hu-Friedy’s proprietary TrueFit technology, a sensorbased system derived by measuring millions of data points for pinch force in the finger and pressure applied to the tooth when scaling. Reducing pinch force by up to 65% and requiring less
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pressure to the tooth when scaling, Hu-Friedy says the instrument’s design helps to alleviate hand fatigue and injury risk due to repetitive motion. With EverEdge 2.0 technology, the working ends of the Harmony instruments are 72% sharper than others, according to Hu-Friedy, enabling calculus removal with less pressure and biomechanical stress on fingers and hands. “The ergonomics [of the Harmony instrument] helped remove deposits easier and with less hand fatigue,” said Mary Aigeldinger, RDH, and hygienist Kim Attanasi agreed. “The design allowed me to scale without using too much pressure, which, in turn, prevented fatigue.” For Maureen Curran, RDH, “the instrument allows for lighter grasp, therefore reducing hand fatigue,” and Michaela Popa, DMD, said the instruments are very sturdy, precise, and cause less hand fatigue. “Due to COVID, many patients have neglected their oral health; a majority had some type of periodontal disease and subgingival calculus. Hand and wrist fatigue has been a major problem,” said Lydia Pope, RDH. “This scaler worked effortlessly. I used much less pressure when scaling, and it reduced my hand and wrist fatigue,” she explained. “I really like the design of the scaler combined with the EverEdge 2.0 technology,” said Jennifer Porter, RDH.
INSTRUMENTS
“I used much less pressure when scaling, and tactile sensitivity was off the charts.” Lydia Pope, RDH New Lenox, IL
“I really enjoyed the feel/grip of the new handle design and liked the sharpness of the blade.” Jennifer Porter, RDH Jacksonville, FL
“Angled loweranterior teeth were a breeze to clean without pinching my handle firmly.”
“The instrument’s design allowed me to scale without using too much pressure, which, in turn, prevented PRACTICE OPERATIONS SOLUTIONSfatigue.” Maureen Curran, RDH Norwalk, CT Kim Attanasi PhD, MS, RDH Staten Island, NY “The instrument’s design allowed me to scale without using too much pressure, which, in turn, prevented fatigue.” Kim Attanasi PhD, MS, RDH Staten Island, NY
Grasp/Grip and Tactile Sensitivity
Overall Satisfaction
The Harmony handle easily adapts to each clinician’s individual grasp, while the optimised shape and scaler worked effortlessly. I used extended silicone grip are well much balanced, providing less pressure when scaling, it reduced my hand and wrist a secure and nimble grasp withand optimal tactile fatigue,” she explained. “I really like sensitivity. the design of the scaler combined
Noting that proper instrumentation “makes our jobs more efficient with less stress,” Curran said, “I really with less stress,” Curran said, The Harmony design allowed like the overall design andlikeplan to order “I really the overall Harmony Curran “to save time Harmony during design and plan to order more.” appointments more.” and have less
with the EverEdge 2.0 technology,” “I like the shape and feel in my hand that enables a said Jennifer Porter, RDH. light grip,” said Deal, and Lauren Dennis, RDH, said, Grasp/Grip and Tactile Sensitivity
“The new ergonomic shape compared to the The Harmony handle easily adapts to each clinician’s individual grasp, original handle provides more comfort, a noticeable while the optimised shape and difference in pinch force reduction.” extended silicone grip are well
Pope said she likes everything aches at the end of the day,” and about the Harmony instruments Aigeldinger saidshe she wanted to use Pope said likes everything about the Harmony and “wouldn’t change a thing,” the instrument frequently, especially instruments and “wouldn’t change a thing,” while while Inman concluded, “I am when a patient had heavy, hard Inman concluded, “I am already recommending already recommending these deposits. instruments am planning on these Satisfaction instruments and am planning onand ordering Overall ordering more.” more.” Noting that proper instrumentation “makes our jobs more efficient
balanced, providing a secure and
Pamela Emard, RDH, stated, “At thegrasp endwith of the day nimble optimal tactile “I like the shape and feel when my hands are beginning sensitivity. to fatigue, I didn’t in my hand that enables a light grip,” have to worry about the instrument slipping from my said Deal, and Lauren Dennis, RDH, grasp.” said, “The new ergonomic shape
PRODUCT EVALUATION SNAPSHOT
compared to the original handle
Curran said, “Angled lower anterior teeth the provides more from comfort, a noticeable difference inpinching pinch forcemy reduction.” lingual were a breeze to clean without Pamela Emard, RDH, stated, “At the handle firmly.” end of the day when my hands are beginning to fatigue, I didn’t have to Pope said the handle’s shape allowed her to apply worry about the instrument slipping a looser, more relaxed grip while removing from my grasp.” deposits, Curran said, “Angled lower anterior teeth from the lingual and it was easy to feel and remove subgingival were a breeze to clean without calculus. “Tactile sensitivity waspinching off themycharts,” shePope handle firmly.” said the handle’s shape allowed her added. to apply a looser, more relaxed grip while removing deposits, and it was Increased Efficiency easy to feel and remove subgingival Harmony Ergonomic Scalers and Curettes calculus. “Tactile “make sensitivity was off the charts,”Laura she added. my job easier and quicker!” exclaimed Inman,
Increasedsaid Efficiency RDH, and hygienist Brooke McCorvey she Harmony Ergonomic “loves the way it adapts. Ease and efficiency areScalers and Curettes “make my job easier pretty awesome.” and quicker!” exclaimed Laura
Pinch force reduction Reduction in pressure applied to tooth Balance
Tactile sensitivity Secure and nimble grasp with extended silicone grips Sharpness of blade (EverEdge 2.0) Overall comfort for clinician SECTION A AVERAGE
Inman, RDH, and hygienist Brooke
Pope used a Harmony scaler on subgingival McCorvey said she “loves the way it adapts. and per efficiency are pretty calculus and said, “Less strokes wereEase used awesome.” Pope used a Harmony tooth. Calculus was removed with ease, [and there scaler on subgingival calculus and was] less pain and discomfort for patient.” said,the “Less strokes were used per tooth. Calculus was removed with
SECTION B OVERALL SATISFACTION
HARMONY ERGONOMIC
SCALERS AND CURETTES The Harmony design allowed Curran “tothere save ease, [and was]time less pain and for the during appointments and havediscomfort less aches atpatient.” the end of the day,” and Aigeldinger said she wanted to use the instrument frequently, especially when a patient Article from Dental Product Shopper March 2022. had heavy, hard deposits. 28
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FINAL SCORE AVERAGE OF SECTIONS A AND B
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INSTRUMENTS
FINALLY, AN ERGONOMIC SCALER THAT’S MORE THAN A BUZZWORD
How we used 2.8 Million Data Points to Advance Dental Ergonomics There’s a lot of talk about ergonomics in the world of dental hygiene. No wonder: working with hand and power instruments can take its toll. According to a systematic review of the literature, nearly 70% of registered dental hygienists experience some sort of hand, wrist, and/or arm pain. Instruments that can reduce the strain on muscles, joints, and bones are the key to increased productivity, longer careers, and, most of all, less pain and fatigue. However, often there is no factual evidence to support the ergonomic benefits of an instrument. That’s why when we set out to design a new line of ergonomic scalers – what would eventually be called our Harmony™ Ergonomic Scalers and Curettes – we wanted to approach the challenge differently. We wanted to know what ergonomics really meant for practitioners. Our goal: To quantify the ergonomic properties of a dental instrument and use that data to design an instrument that significantly reduced the strain of clinicians. With the new Harmony™ Ergonomic Scalers and Curettes, we did both. Let us walk you through the rigorous testing process. 2.8 Million Reasons to Believe To design a genuinely ergonomic scaler, we first needed to understand what key factors contribute to musculoskeletal disorders among hygienists. While scaling involves small micro-motions, these fine movements adds up over the days, months, and years. Because scaling is a fine motor skill, the sensitivity of the testing equipment was critically important. We partnered with global leading technology firms to custom design a device that would:
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Adapt to all users’ grasps, as well as all scaler designs.
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Not interfere with the practitioners or the instruments being tested.
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Allow our engineers to create an iterative development process.
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Help us grow and build a database for ergonomic applications.
What our team came up with was TrueFit™ Technology. The TrueFit™ Technology system consists of two main components: four finger sensors (which resemble a thin glove) that record pinch force (the pressure required to hold an manipulate an instrument with your hand) and a typodont outfitted with a six-axis force/torque sensors to record the pressure applied to the tooth. The TrueFit™ Technology system recorded 40 measurements per second from every sensor in the system. All this information fed into a custom software system that analyzed and interpreted the pinch force that hygienists exerted during scaling and the pressure applied to a patient’s tooth. Enabled by the revolutionary TrueFit™ Technology, our team undertook a rapid prototype development process, similar to that used in software engineering. Starting with a gamut of handles currently available on the market, we gathered data and applied it to a range of innovative new design concepts. These different handle designs helped establish comparison points for iterative development. We kept the features that tested well and discarded those that performed poorly. Over 50 hygienists spanning continents and countries participated in the testing, and we partnered with a third-party analytics firm to review and analyze the data collection. By the completion of the project, we had gathered over 2.8 million data points. Click here review the data for yourself.
INSTRUMENTS
Confidence in Your Hand
Taking a Hand in the Fight against Fatigue and Strain
Compared to other “ergonomic” scaler designs from leading instrument manufacturers, the Harmony™ Ergonomic Scalers and Curettes reduce pinch force up to 65%, and reduce the pressure applied to the tooth by up to 37% (which your patients are sure to appreciate). The Harmony™ Ergonomic Scalers and Curettes achieve these amazing strain-minimizing results through a combination of features:
When you apply force repetitively and over time, inflammation occurs in your muscles and tendons. The higher the force, the quicker your muscles become fatigued. Eventually, nerve damage and disorders such as carpal tunnel syndrome may set in. By reducing the pinch force you must apply to a scaler, you can reduce the likelihood of injury. And the less pain you have, the more satisfied you’ll be at work.
•
The durable metal handle, which features a recessed double-helix texture, is designed for optimal tactile sensitivity and to reduce tactile fatigue. (Your tactile sensitivity of the tooth surface will diminish less over extended use.) • A silicone grip extended 30%, allowing a secure and nimble grasp while using the instrument. The geometric pattern is specifically designed to maximize grip in all directions. • An organic, round shape designed to roll smoothly in the fingers, potentially alleviating hand fatigue and injuries from repetitive motion. • A 20% increase in width WITHOUT an increase in weight. Harmony™ Scalers and Curettes also feature our EverEdge™ 2.0 Technology. With EverEdge™ 2.0 Technology, working ends are 72% sharper out-ofthe-box than the next leading competitor and 50% sharper after 500 strokes. Sharp scalers require less pressure to accomplish the same amount of work, creating more comfort for you and your patients.
We ran our findings by two unaffiliated occupational therapists. They told us, “By using the new Harmony™ Scaler, a reduction of biomechanical stress on fingers and hands will occur compared to other available scalers on the market.” To sum up, the outcome of all our research, testing, and development is a happier, more comfortable, more productive workday for you as a clinician. That translates into:
• • • • •
Decreased onset of hand disorders. Less muscle fatigue. Fewer worker’s compensation claims. A boost in efficiency. A potentially longer and more fulfilling career.
Clinicians agree. Take a look at what others are saying about Harmony™ Ergonomic Scalers and Curettes. “I could feel the difference in my grasp the first time I scaled with a Harmony™ Scaler.” TAMI WANLESS RDH, MED “While using the new Harmony™ Ergonomic Scaler with sharp EverEdge™ 2.0 Cutting Edges, I have great tactile sensitivity and I feel a perceptible decrease in pinch force and pressure required for effective calculus removal.” ANNA PATTISON RDH, MS
The Harmony™ Ergonomic Scalers and Curettes are now available in 30 of our best-selling sickle scalers, universal curettes, and Gracey curettes. Learn how to scale in Perfect Harmony!
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DENTAL SOLUTIONS
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INFECTION CONTROL
TESTING YOUR ULTRASONIC BATH CORRECTLY AND SAFELY
As part of our daily testing requirements as required by the AS/NZ 4815:2006 standard it specifies that daily performance testing e.g. foil test or pencil load test is required. The most common method we see in practice is the foil test, however, there seems to be varied techniques and types of foil being used. As a general rule you should always refer to the manufacture of the ultrasonic cleaner to determine how a foil test is to be performed. But also become familiar from a safety perspective how to handle and operate the machine and tests. Safety First! No part of your hands should be submerged into the cleaner during operation as the ultrasonic waves are enough to cause damage to joint tissues and could result in long-term arthritic conditions. The lid should also be closed in order to prevent excess emission of noise and aerosols. Lastly the product you’re using should be handled carefully and diluted correctly to prevent skin irritations and workplace health and safety concerns.
Step 1: Fill tank with tempered water
Step 2: Add recommended dose of solution
Step 3: Degas
Step 4: Run foil test or pencil load test
Step 5: Add basket and instruments
Step 6: Close lid
Step 7: Run Ultrasonic Cleaner
Step 8: Remove basket and set on unit to drain
Step 9: Rinse instruments off with water
Step 10: End of day– empty tank
Step 11: Rinse the tank and wipe clean with a soft cloth moistened with a mineral deposit remover and then with a mild disinfectant
Ultrasonic Cleaner Reference Guide 1
Step 1: Fill tank with tempered water
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Step 2: Add recommended dose of solution
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Step 3: Degas
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Step 4: Run foil test or pencil load test
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Step 5: Add basket and instruments
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To view the full Coltene Ultrasonic Cleaner Reference Guide
Step 6: Close lid
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INFECTION CONTROL
HU-FRIEDY BAGETTE SELF-SEALING STERILIZATION POUCHES
Hu-Friedy’s Bagette® self-sealing sterilization pouch line includes a variety of sizes created to fit all sterilization needs: •
Four pouch sizes specifically designed to fit all of Hu-Friedy’s IMS Signature Series cassettes.
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Additional sizes are available for the sterilization of other items including rubber dam clamps, burs, handpieces and loose instruments
Internal and external indicators for both Steam and EO Sterilization. Responds to all variables of sterilization: time, temperature and presence of steam
Thumb notch for ease of opening
High quality medical grade paper and multi-layer blue tinted film provide strength and durability
Thick, strong thermal seal to protect against cassette and instrument breaches
Wide self-seal adhesive strip to provide reliable seal
Pouches are lead free and are not made with natural rubber latex
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INFECTION CONTROL
COLOR CHANGE GUIDE Below is a color change guide to aid in the interpretation of the color change that occurs when the pouches are processed in an autoclave, or ethylene oxide sterilization chamber. Ideally, the indicator should change color from the first box to the last box, but due to the large variation in sterilization chambers, this is not always the case. Therefore, there is a suggested acceptable range of color change. See diagrams below for details.
STEAM STERILIZATION
EO STERILIZATION
Caution: the chemical indicators are to be used as a sterilization process indicator only. The indicators should be used in conjunction with biological indicators (spore strips) to ensure the devices within the pouches are sterile. For more information on Hu-Friedy SporeCheck 24 hour in-office biological montitor system please visit our website.
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INFECTION CONTROL
HOW DOES CHEMICAL PERMEATION AFFECT DENTAL GLOVES?
A glove that protects against one type of chemical may offer poor protection against another chemical. Different types of gloves protect against different types of chemicals. This means that dental professionals should carefully choose their gloves in part based on the chemicals they may be exposed to during their work.
Are gloves made equal?
Many may assume that two gloves with a similar thickness made with the same polymer would have the same ability to resist a chemical. This, however, is not always the case. The formulation and manufacturing process used in making a glove can have an impact on how long it can resist chemicals. The ability of a glove to protect for a given length of time against a given chemical/mixture can therefore only be determined by testing specific gloves against specific chemicals/mixtures.
The simple, everyday movements that a person makes while wearing a glove and performing job tasks can affect how quickly chemical permeation occurs. In chemical permeation tests that simulate these types of everyday movements, chemical breakthrough times are significantly shortened. Abrasion, even in controlled, non-severe conditions, may compromise to varying degrees the barrier integrity of latex, vinyl, SEBS, nitrile, and neoprene glove materials. 1-4
Polymer
Good resistance to
Poor resistance to
Natural Rubber
Aqueous solutions Acids Bases Alcohols
Organic chemicals Oils Ketones
Many solvents (organic) including Aliphatic Hydrocarbons, oils, fats
Strong acids Halogenated hydrocarbons Aldehydes Ketones
Aldehydes Acids Bases Alcohols Different solvents
Aromatic solvents Halogenated solvents Ketones
Nitrile
Neoprene
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Another factor complicating our ability to determine how long gloves can resist chemicals is glove movement.
INFECTION CONTROL A medical glove’s ability to resist chemicals is limited in time. The length of time it can resist the chemical depends upon several factors. These include:
Permeation is measured in the number of minutes it takes for a chemical molecule to pass through the glove material.2,8,9
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The type of material the glove is made from
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The quality of the formulation and manufacturing process used when making the glove
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The thickness of the glove material
Increasing awareness about the health risks of chemical exposures among dental professionals and evaluating chemical permeation of dental products against medical grade gloves helps address and minimise occupational contact dermatitis in dentistry.
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The composition and concentration of chemical in the product or chemical mixture chemicals
To read the full white paper on ‘Protecting Hands from Chemicals in Dentistry’, please CLICK HERE
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The frequency and duration of contact with the chemical mixture (short or long period of time)
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The nature of chemical contact (total immersion, or exposure to a “splash”)
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The temperature of the gloves (at higher temperatures, it will take less time for a chemical to penetrate a glove than it will at lower temperatures
After a while, the chemical will penetrate the medical glove material, often without being noticed.
Chemical Penetration
The penetration of chemicals and/or microorganisms is a process which can be defined as the flow through closures, porous materials, seams, and pinholes or other imperfections in a protective or medical glove material. Penetration occurs on a nonmolecular level and can lead to contact with hazardous chemicals or infectious materials, especially in the healthcare field.5-7
References 1. Lönnroth EC, Eystein Ruyter I. Resistance of medical gloves to permeation by methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA). Int J Occup Saf Ergon. 2003;9(3):289-99. 2. Phalen RN, Le T, Wong WK. Changes in chemical permeation of disposable latex, nitrile, and vinyl gloves exposed to simulated movement. 3J Occup Environ Hyg. 2014;11(11):716-21. 3. Phalen RN, Wong WK. Chemical resistance of disposable nitrile gloves exposed to simulated movement. J Occup Environ Hyg. 2012;9(11):630-9. 4. Walsh DL, Schwerin MR, Kisielewski RW., et al. Abrasion resistance of medical glove materials. J Biomed Mater Res B Appl Biomater. 2004 Jan 15;68(1):81-7. 5. Mellström G. Protective gloves of polymeric materials. Experimental permeation testing and clinical study of side effects. Acta Derm Venereol Suppl (Stockh). 1991;163:1-54. 6. Lowbury EJL, Lilly HA. Disinfection of the hands of surgeons and nurses. Brit Med J 1960:1445–50. 7. Hoborn J. Human as dispersers of microorganisms – dispersion pattern and prevention. [Theisis] Göteborgs universitet 1981. 8. Richards JM, Sydiskis RJ, Davidson WM., et al. Permeability of latex gloves after contact with dental materials. Am J Orthod Dentofacial Orthop. 1993 Sep;104(3):224-9.
Chemical Permeation Permeation is a process by which a chemical can pass through a protective film without going through pinholes, pores, or other visible openings.
9. Tinsley D, Chadwick RG. The permeability of dental gloves following exposure to certain dental materials. J Dent. 1997 Jan;25(1):65-70.
Individual molecules of the chemical enter the film, and “squirm” through by passing between the molecules of the glove compound or film. In many cases the permeated material may appear unchanged to the human eye.
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DR MIKAEL ZIMMERMAN DDS, PhD
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INFECTION CONTROL
SOIL TESTS AND DETERGENTS FOR YOUR FACILITY
Why do we use soil tests? All machines (including thermal washer disinfectors and under-bench washers) are validated to ensure the machine is capable of meeting a given range of parameters and to ensure the desired result is achieved. After validation though (which occurs once a year, unless a change has occurred) we have no independent way of knowing that the machine is continuing to perform to the validated parameters. So, we need to employ the use of tests for periodic and routine monitoring of our machines. This is why we use soil tests in our washers. A fact that may not be realised though, is that a soil test doesn’t tell us that our instruments are clean. All it tells us is that the process has performed correctly. Soil tests can pick up issues with the machine that may have potentially gone unnoticed. For example, a machine may not know if the detergent bottle is empty or if the tubing or piping to deliver the detergent is blocked, or whether the detergent has expired or perhaps wasn’t stored correctly and thus isn’t performing at its best, or whether there has been a change in water quality (maybe the water hardness has changed – which is worse for instruments and requires more detergent), or whether instrument trays have been overloaded, or whether one of the spray arms is not working as it should. In many under-bench washers in dental practices, we can’t see behind the washer door, so we have no idea of what’s happening in that process. Why should you track the cleaning process in your washer disinfector? The cleaning process of surgical instruments in any clinical facility is extremely important because cleaning removes the greatest proportion of soiling and contaminants on the instrument surface. A subsequent sterilisation process kills any remaining microbes. You may know the age-old adage that “If an instrument isn’t clean, it can’t be sterilised.” The cleaning process is also a little more complex than you may think with a wide variety of factors and variables affecting the success of a process. Every cleaning process comprises elements of temperature, time, chemistry (i.e. detergent) and mechanics, in varying proportions. But we also have some added variables when we are talking about our instruments.
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For example, instrument design (eg material, surface type, hollow/solid, etc), water quality (eg town water, deionised or reverse osmosis water, etc), and machine performance (eg how old the machine is, when it was validated, etc). So, we need an independent way of monitoring our process to ensure continued performance. Therefore we use soil tests. How often should a soil test be used? There is recent guidance in the dental industry to use a soil test in every load. While this may seem like overkill, this guidance has its merits for the reasons listed above. We cannot know for sure that the process has performed as it should without an independent test to verify.
INFECTION CONTROL
The GKE Soil Tests
pH alone though may not be sufficient to “clean” instruments therefore, detergents can also have added enzymes.
GKE offer a range of cleaning process indicators (i.e. soil tests) to assess the cleaning process.
Enzymes help to break down biological compounds like proteins and fats. Remember that blood contains proteins.
There is a range of colours which react differently depending on the parameters of the process, such as pH, temperature, and mechanics.
So, the choice of detergent is very important, and the quality of the detergent can have a big impact on the longevity of instruments.
There isn’t a one size fits all approach to the cleaning process (because there are so many variables), that’s why GKE offer several different coloured indicators with different wash-off capabilities.
It’s important to check instrument IFU’s and the recommendations from the manufacturer, however it is more than likely that instruments can withstand a mildly alkaline detergent, even if a pH neutral is recommended.
We discussed above how there are so many factors at play in any cleaning process, therefore there cannot be one soil test for verifying all cleaning processes.
This can be discussed with the detergent and instrument manufacturers further.
What role does detergent play in the cleaning process?
GKE Australia recommend the Dr Weigert neodisher MediClean forte, which is a mildly alkaline and enzymatic detergent with added corrosion inhibitors, which act to protect instrument longevity in the longterm.
Like with any cleaning process, we need soap. Whether we are cleaning our hair, our dishes, our car, or our dental instruments, we need a detergent that contains surfactants to break down the surface tension of water and disperse contaminants, soilings (eg cements and amalgams), bio-burden etc.
If you would like to know more about assessing your Cleaning Process and the GKE Australia Products – contact your Henry Schein Territory Manager or you can contact GKE Australia directly.
All detergents have a pH – they can be acidic, pH neutral or alkaline and anywhere in-between. Many guidelines and standards (including AS/ NZS 4815 and 4187) recommend that a mildly alkaline detergent is better for the cleaning of surgical instruments (inclusive of dental instruments) because solutions with increasing alkalinity are better able to hydrolyse (i.e. break down) the compounds and contaminants on our instruments.
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LAUREN KONTUS BSc (EnvSc) Sales and Contracts Manager GKE Australia
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INFECTION CONTROL
BENEFITS OF A WASHER DISINFECTOR IN INSTRUMENT RE-PROCESSING
Instrument reprocessing is a critical function completed by every dental practice every single day. Practice
owners are looking to make their workplace safer and more efficient and where possible, reduce operating costs. Using an automated washer disinfector unit to clean instruments prior to sterilizing offers several advantages. There are many steps involved with the tedious process of manually cleaning instruments. It can be an inefficient and time-consuming process. You may need to soak the instruments, scrub by hand, rinse and then dry by hand. All these functions take time and require the full attention of the staff member completing the task to ensure it is completed correctly and to avoid sharps injuries or damage to expensive, fine instruments. The process is tedious and can quickly cause a bottleneck in instrument reprocessing for busy practices, particularly if there is a shortage of staff. Alternatively, an automated washer disinfector is an efficient, validated process delivering reproducible results every time. Instrument damage is eliminated. The potential for sharps injury is significantly mitigated. And it offers real cost savings over time. Dirty instruments go straight from the surgery into the washer disinfector, the cycle completes, and the instruments are clean and ready for packaging and sterilization. Once you have a washer disinfector in your practice, there is never any doubt that this is the future.
JIM OWEN Sales Relationship Manager Mocom-Australia
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To quote the relevant standard – AS/NZS 4187:2003 – Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities, it states “the use of an automated cleaning process in a washer disinfector is the preferred means of cleaning, as an automated process is more reproducible than a manual cleaning process”. Mocom’s Tethys range of benchtop and under bench automated washer disinfector
There are four models– three under bench and one benchtop unit. 1. Mocom Tethys T45, which is a 45-centimetrewide unit that is ideal for when under bench space is tight. It only comes in single phase power and does not have a drying cycle. 2. Mocom Tethys T60, which is a full-size unit with a width of 60 centimetres that comes in single or three phase power and without a drying cycle. 3. Mocom Tethys D60 which is the same as the T60 but includes drying cycle. 4. Mocom Tethys H10 is a compact benchtop unit and it’s quite unique. It uses the power of ultrasonics to clean instruments, which means it only takes 35 minutes for pre-rinsing, washing, disinfection and drying. It’s perfect for smaller practices, or large practices that want a second washer disinfector unit that can turnaround small quantities of instruments fast.
INFECTION CONTROL
CRITICAL ASPECTS AND SOLUTIONS FOR DENTAL UNIT WATERLINE MANAGEMENT
Why is it important to maintain the Dental Unit Waterlines? Biofilm is a collection of microorganisms that adheres to the inner surface of the dental unit waterline as a thin slimy layer secreted by the bacteria. Most commonly, found pathogens in the biofilms that form within the dental unit waterlines are Pseudomonas aeruginosa, non-tuberculous mycobacteria, and Legionella species. It is well documented that bacteria flourish in the waterlines of a dental unit because the lines to the handpieces, triplex syringe, and ultrasonic scaler are narrow in diameter. Hence, have very slow flow rate and water gets stagnated over time if the lines are unused, which makes it a perfect conditioner for biofilm to accumulate. Importantly, dental staff must wear gloves when handling water bottles or adding in chemical treatment agents to prevent skin bacteria from contaminating the water in the bottle. Why is it recommended to maintain the water quality in your everyday practice? Following the Centre for disease control and prevention (CDC) guidelines for infection control and Australian Drinking water guidelines, the number of bacteria in water that enters the patients oral cavity during non-surgical dental procedures should be less than 200 Colony forming units (CFU)/ml. Water quality can be tested easily, economically, and effectively by the practice staff using dip slide test. When tested levels are found to be above the target level of 200 CFU/mL, the waterlines must undergo shock treatment to maintain the drinking water standards. Ensure that any shock treatment or sanitizing
agent used to maintain the dental unit waterlines is compatible with the dental chair and is flushed completely from the waterlines before using the chair. The water quality should be checked more frequently after sanitizing, it is recommended to test the waterlines using dip slides/sticks-every 3 months to ensure that the biofilm control measures being used are adequate. Thereafter, daily use dental unit waterline management solutions or tablets must be used to prevent build-up of bacteria within the dental unit waterlines. Treatment solution or tablets should be added to the water bottles before filling water at the start of each day and dry bottle are installed at the end of each day. The practice must ensure to follow manufacturers instructions while using any waterline management product. References
1. ADA Infection control guidelines, page 30 2. CDC (2003) Guidelines for Infection Control in Dental Health-Care Settings, page 29. 3. Australian Drinking Water Guidelines 6 2011, Version 3.7 Updated January 2022 4. Depaola LG, Mangan D, Mills SE, Costerton W, Barbeau J, Shearer B, Bartlett J. A review of the science regarding dental unit waterlines. J Am Dent Assoc. 2002 Sep;133(9):1199-206; quiz 1260. doi: 10.14219/jada.archive.2002.0361. PMID: 1235625 5. https://www.cdc.gov/oralhealth/infectioncontrol/ faqs/dental-unit-water-quality.html
RASHI JAIN BDS, PhD Infection Control Category Manager Henry Schein Australia
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1300 65 88 22 henryschein.com.au