Dental Solutions May / June 2022

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

MAY / JUNE 2022

8 -23

68 - 76

46 - 57

ENDODONTIC SOLUTIONS

INFECTION CONTROL SOLUTIONS

Our Solutions

EQUIPMENT SOLUTIONS

Our Brands 77-79

Hu-Friedy Group

50-51, 58-62

Cosmetic & Restorative

24-35

3 Shape

Digital Solutions

77-82

Ansell

45

Kavo

63-65

Aquacare

36

Komet

19-21

Kuraray Noritake

30-32

MicroMega

88-89

Mocom

54-55

Morita

9, 57

Endodontic Solutions

8-23

Equipment Solutions

68-76

B&L

12

Handpiece Solutions

57, 63

Busa

8

Infection Control Solutions

44-55

Calmix

16-18

Instrument Solutions

58-67

Cattani

76

4, 86-90

Coltene

13-15, 22-23, 48, 83-85, 88-89

6-7

Colgate

38-39

New Products Orthodontic solutions

Planmeca Reveal

68-69 6-7

Pain Control Solutions

40-43

Dentisan

49

SDI

Practice Solutions

44-45

Durr Dental

75

Septodont

40-43

8, 10-11

Sieverts

70-74

24-27, 87

Ultradent

34-35

Preventative Solutions Prosthetics Solutions

36, 38-39 83-85

EdgeEndo GC

Upcoming Events

32-33

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GKE Australia

46-47

Henry Schein

44, 52-53, 70-74, 90

Vita

80-82

56

Zirc

66-67

Henry Schein One

As your trusted business partner, Henry Schein is not only here to help you in the day to day running of an existing practice, but also in your exciting journey if you decide to take the exciting leap and open a practice of your own, or even adding additional practices to your portfolio.

Whilst this edition of Dental Solutions details products and workflows that can help your practice and patient experience, I also wanted to draw your attention to other services and expertise that we can offer you as well.

Surgery Setup Solutions The decision to open a new practice can be daunting with lots of considerations, from location planning and fit-out to recruitment and financing, but rest assured, Henry Schein is here to help. With decades of experience and a wealth of knowledge across our Relationship Managers, Equipment and Specialist teams you can be confident we are here to help every step of the way.

At Henry Schein, we strongly believe in supporting you throughout the setup process so we can help your practice thrive and grow long into the future. On this basis, I would like to introduce to you our Surgery Setup Solutions created to help make the purchasing process of your equipment and consumables as simple and cost effective as possible.

By partnering with Henry Schein for your full setup you get the following benefits:

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Competitive pricing on our range of market leading Equipment and CAD CAM products

•

50% Off your consumables setup bundle when purchased with equipment*

•

The option for 3 years of Exact Practice Management Software access for free*

•

Free installation of your equipment

We also partner with the industry’s leading finance companies to provide you with flexible financing options tailored to your new practice needs.

Beyond this offering we can also connect you with experts in design, fit-out and practice consulting to, so we can ensure your practice has everything it needs to succeed when it opens its doors on day one!

If you are interested in the setup of a new practice, ask your relationship manager or complete the form below and a member of our dedicated team will be in touch to help you start your journey. *Terms and conditions apply

Scan here to read more about our Surgery Setup Solutions

Enquire today

DID YOU KNOW HESY-RE WAS AN EGYPTIAN SCRIBE WHO LIVED AROUND 2600 B.C. AND IS RECOGNISED AS THE FIRST DENTAL PRACTITIONER

ONLINE

JANINE VINCENT National Sales Manager

BRETT BUTCHER Equipment Business Unit Manager

TV

CALUM COOGAN Marketing Communications Digital & CX Manager

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NEW PRODUCTS

NEW PRODUCT SPOTLIGHT

Henry Schein in conjunction with our global supplier partners are committed to sourcing and supplying the latest and highest quality products to support the advancement of dental professionals and patient care in Australia. Check out the latest additions to Henry Schein’s range, available online, or through Customer Care and your Relationship Manager.

GC Modeling Liquid Simplify your composite work using GC Modelling Liquid with your brush or Instruments With the right tools, a smooth and well-sculpted direct composite restoration is achievable, resulting in a nice aesthetic outcome. Read more on page 85

MicroMega One RECI A single-use reciprocating instrument for root canal shaping. Made of Nickel Titanium, MicroMega One RECI, thanks to its patented C.Wire heat treatment, offers excellent compromise between flexibility and cutting efficiency. Read more on page 86

Dual Move Motor & CanalPro Solutions Cordless endodontic motor with well-balanced, in-hand, silent endodontic motor for control of movement, speed and torque, offering freedom, comfort, and optimal security when shaping the root canals. Display turns around in order to suit to left-handers, and contra-angle rotates without being disconnected from the handpiece. Read more on page 87

Endoflex™ C-FILES & Eurosept Xtra Waterline These files assist with locating the root canal and are recommended for calcified, curved, and narrow canals. EuroSept Xtra Waterline treatment is used to reduce microorganisms in the water-bearing system of dental treatment units. A ready-touse solution specifically for the automatic dosing systems of treatment units.

Read more on page 88

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UPCOMING EVENTS

UPCOMING EVENTS

Your FREE go-to resource for Dental Education and CPD. Explore over 270 hours of clinical and business related content all in one place with access to courses, webinars, podcasts and articles.

Explore our upcoming courses and webinars below

Hyflex Hands on Courses

Clinical Courses Dr. Gordon J. Christensen Acess courses online until January 2023

Dr Humza Ahmed, Dr Bobby Patel, Dr Shalin Desai 3 CPD Credits

Reveal Clear Aligners Online Training Fri 6 May Dr Melissa D. Shotell 6 CPD Credits

Endodontics Unpacked Mon 23 May OR Sat 9 Jul Dr Harry Mohan Dr Aaron Gascoigne 8 CPD Credits

6th Australasian Digital Dentistry Symposium

MicroMega One Reci Hands on Dr Martin Habibi, Dr Bobby Patel, Dr Shalin Desai 3 CPD Credits

Fri 29 Jul – Sat 30 Jul Hamilton Island, QLD 14 CPD Credits

D en t al e d u c a t i o n h u b.c o m.a u

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ORTHODONTIC SOLUTIONS

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 Narrow upper arch, crowding, cross bite, 15 year old female

Aesthetics and cross bite of upper left 2nd premolar.​

Pre Treatment

Treatment Planning Upper arch expansion to correct cross bite and IPR in upper and lower arches to correct alignment.​ Number of aligners: Upper 22 Lower 17

Duration of treatment: 12 months No attachments. No revisions.

Final Results

Treatment Notes During-treatment Complications: Patient lost upper 12th aligner during the treatment and was requested to jump on to next aligner.​ Post-treatment Assessment: Upper left lateral was not completely derotated. This was due to less wear time of aligner no. 12. * Data on file for US population

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ORTHODONTIC SOLUTIONS

Case Description

Patient Chief Complaint

Prominent upper canines, upper midline correction, 31 year old male

Prominent upper canines, upper midline correction.

Pre Treatment

Treatment Planning Accommodate upper canines by moving them distally in to the spaces created by Inter Proximal Reduction (IPR) in posterior teeth. ​

Number of aligners: Upper 15 Lower 15 Duration of treatment: 9 months No attachments. No revisions.

Final Results

CASE BOOK

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ENDODONTIC SOLUTIONS

ENDODONTIC CASE REPORT TOOTH #46

Case Study The patient was referred to our endodontic practice for evaluation and treatment of tooth 46.

Clinically #46 had an all-ceramic crown, a negative response to cold, and tenderness to percussion.

Pre-op x-ray revealed #46 had a periapical radiolucency associated with the Distal root and severe D root curvature in the apical third.

Endodontic diagnosis Pulpal Necrosis with Symptomatic Apical Periodontitis.

Pre-Op Tooth #47 accessed, located MB, ML, and DB and DL canals. Canals instrumented with Edge X7 rotary files using a crown down technique

Cone Fit Working lengths were determined via apex locator followed by radiographic confirmation. The canal system was obturated with BUSA BC Sealer and BC GP Point. The access was immediately re- stored with a fiber reinforced dual cure core material.

Post-Op Sequence of files for ‘crowndown’ (with MAF sizes) X7s 25.06 to resistance, then 20.06 to resistance, then 25.06 to resistance.

Working length hand file to 15, 17.04 if necessary, 30.04, 35.04, 40.04.

For this case, I vigorously used hand files above my typical sequence to a #35K and finished with an X7 35.04 at 500 RPM 2.6 N/cm torque.

JAMES A. WEALLEANS D.M.D., American Board Certified Endodontist, Adj Professor, Clinician Sydney, Australia.

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ENDODONTIC SOLUTIONS

APEX LOCATION AN ENDODONTIST’S PERSPECTIVE

“We’ve always bought and used Morita ZX apex locators and the Dentaport ZX that we are currently using is a number of years old now. Apex locators are manufactured by a lot of different companies and there are many models on the market.

I’m sure they’re all good instruments, however, I prefer the Morita apex locators because of their reliability and longstanding track record.”

Dr John Barbat, North Shore Endodontic Services, Chatswood, NSW

The History

The Benefits

Prior to the early ’90s, electronic apex locators were notoriously unreliable.

They used a single current that would often complete the electronic circuit when the file wasn’t at the apex.

It improves efficiency, saves time and reduces patient radiation. The locator gives a very accurate length measurement that is confirmed with an X-ray.

The Morita ZX system eliminates this electronic variability by using two currents of different wave frequencies simultaneously.

This means you know where you are before taking the X-ray. Without the locator reading, it’s highly likely that a succession of X-rays would be needed to achieve the same result.

The relationship between these two currents changes as the biologic constriction is approached.

Recommendations There is a degree of technique sensitivity when using this instrument. Care must be taken that short circuits aren’t created by metal restorations. Irrigants used in canals are electrolytic, so if there is any leakage it can also create false readings.

The Research There’s a plethora of research into this particular instrument. It’s a favourite of endodontic master’s students to investigate and write their thesis.

However, any errors are pretty obvious and these can usually be overcome.

Most of the research shows that this apex locator is highly accurate to within 0.5 and 1mm of the biologic constriction of the tooth.

DENTAPORT ZX Apex Locator

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ROOT ZX Mini

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ENDODONTIC SOLUTIONS

ENDODONTIC CASE REPORT HYBRIDISING HEAT TREATMENTS TECHNIQUE

A 42 year old female patient came to the office complaining about crown fracture and severe pain in the left mandibular posterior area.

Intraoral and radiographic examination revealed disto-occlusal decay in tooth 3.6 (fig1), and exposure of the distal pulp horn. Tooth was highly sensitive to thermal cold test; an acute pulpitis was diagnosed and an endodontic orthograde treatment was proposed and accepted. Following a minimally invasive approach, access cavity was designed starting from the distal portion of the tooth, to avoid unnecessary loss of dentinal structure.

Such a decision was a compromise between the advantages provided by a wider, straight line access (which is ideal in complex narrow curvature like in the present case) and the disadvantages from weakening the residual tooth structure: the mesial marginal ridge was intact, and it was decided to preserve it according to minimally invasive endodontic protocols. Moreover, an ideal straightline insertion of endodontic nickel-titanium (NiTi) rotary instruments is not always possible when a molar is slightly distally inclined, like the present case. More complex root canal configurations (i.e. when additional canals are present like in this case) require more attention in planning adequate endodontic access to properly reach all the different orifices.

As a consequence, clinician was aware that NiTi rotary instruments would have been subjected to high flexural stress, due to the presence of multiple curvatures, which also required flexibility to be negotiated with no iatrogenic errors. Therefore, the first parameter was the selection of extremely flexible, heat treated, controlled-memory martensitic NiTi instruments; the second one was the selection of instruments with variable tapers to minimize taperlock and screwing-in effect; the third parameter was the selection of instruments with enough metal

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mass to withstand torsional loads in narrow canals.

The choice was in favor of EdgeTaper Platinum (ETP) by EdgeEndo, Albuquerque, NM, which provided all the required features; very resistant and flexible instruments, which can be deformed more easily than competitors’ file and maintain the given precurvature, allowing an easier insertion and minimizing the need for a wider access cavity.

After a manual glide-path with stainless steel K-files up to size 15, and working length determination with an electronic apex locator, ETP instruments were used with the following sequence: S1, S2, F1, F2. All instruments reached the full working length, gently rotated at 300 rpm (and 2N torque), avoiding overloading. Two crucial operative parameters were chosen; first, during inward motion, instruments progressed slowly, in steps (not more than 1-2 mm progression for each step) and after each step they were removed from canals, the flutes were cleaned and syringe irrigation performed. Such a careful progression allowed to avoid excessive friction due to wider blade engagement and reduced debris inside the flutes. Moreover, debridement was enhanced with more frequent irrigation, and less production of debris.

The second parameter was the use of outward motion to improve coronal flaring. This could have been done with the same ETP instrument, but for the S1 and S2 instruments slightly more rigid EdgeTaper (ET) rotary instrument were chosen. ET instruments have same design of ETP but no heat treatment, which makes them a bit more stiff and efficient in cutting. Therefore, ET S1 and S2 (used after ETP S1 and S2, respectively) allowed a more rapid and valid coronal flaring.

ENDODONTIC SOLUTIONS

They were used only with an outward motion (“brushing”), an increased speed (500 rpm) and reduced torque (1.5N). By eliminating coronal interferences and increasing canal diameters ET S1 and S2 made apical preparation with ETP F1 and F2 quicker and safer, as shown in the CBCT images (fig 2 and 3). Outward motion was found to be extremely safe, with minimal torsional and flexural loads on the NiTi rotary instruments, provided that the instruments are never fully engaged or blocked inside canal.

This new, innovative combination of similar instruments (ET and ETP) with different properties related to a different manufacturing process, is called“hybridizing heat-treatments technique” and

was nicely performed using the above-mentioned instruments.

Fig 3 and 4 show how canal trajectories were nicely maintained, and proper shaping (adequate canal diameters can be better appreciated in 3D images, as shown by figures 2 and 3) was quickly and simply performed in a 45-minute single-visit root canal treatment, with no iatrogenic errors, no instruments’ deformation or fracture.

Canals were obturated with a single cone cold hydraulic technique using Bioceramic Sealer (BC Sealer, BUSA, USA), a material that provides a simple and fast solution.

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

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ENDODONTIC SOLUTIONS

TIPS FOR WARM VERTICAL CONDENSATION

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5.

6.

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You need two devices – one heated plugger and one back fill unit. (e.g. B&L SuperEndo Alpha and Beta) and to take your treatment to the next level we suggest endodontic pluggers such as B&L’s NiTi/SS Kondensors.

Ensure the canals are prepared adequately, disinfected and dried. True warm vertical obturation works consistently with small apical size and larger taper preparation techniques eg. #25 .06.

Alpha unit

Beta unit

Insert your sealer coated master GP point into the canal and trim off the excess at orifice level using the B&L Alpha heated plugger.

Condense your GP at the orifice level using the large SS end of your B&L Kondensor.

Activate the heated plugger and Insert into the canal, applying firm pressure.

Stop 1mm from the marked stopper.

8.

De-activate the heat, whilst still maintaining apical pressure for approximately 8-10 seconds.

9.

Activate the plugger again and push 1mm apically and swiftly pull the plugger out along the curvature of the canal. Do this step quickly in 1-2 seconds. This will leave an apical plug.

10. Condense the apical GP with the fine NiTi end of the B&L Kondensor.

Select your master GP point based on the minimum size of the apical constriction and ensure there is adequate tug back.

Select a plugger tip that goes within 4-5mm of your working length. Mark the depth at which it binds to the canal with a rubber stopper.

7.

11. Place the pre-heated needle of the backfill unit (B&L Beta) into the canal, resting on the apical portion of the GP. Extrude the warmed GP and let the pressure of the extruded GP push the tip out of the canal. Do not pull back as this can create voids!

12. Condense the expressed GP into the canal carefully with an endodontic plugger.

B&L Kondensors

It is recommended that you practice on extracted teeth first to gain confidence.

ENDODONTIC SOLUTIONS

HYFLEX EDM CASE REPORTS SHAPING OF AN ABRUPT CANAL CURVATURE IN A DISTAL MOLAR

User Benefits • Fast, safe and efficient shaping of root canals despite abrupt curvature. Due to the innovative manufacturing process Hyflex EDM files are extremely flexible and fracture resistant.

• Comfortable treatment of hard to reach distal teeth. HyFlex EDM files can be pre-bent similar to stainless steel hand files.

Diagnosis • Patient presented with necrotic pulp and symptomatic apical periodontitis of tooth #18 (Universal Numbering System).

Challenge • Limited opening and limited space for instrumentation due to very distal position of the tooth.

• Root canals highly curved with sudden sharp dilacerations.

Conclusion The HyFlex EDM file sequence is ideally suitable for safe and efficient preparation of hard to reach distal molars with abrupt canal curvatures. Due to the EDM manufacturing process, HyFlex files are extremely flexible and fracture resistant.

Treatment • Preparation with pre-bent HyFlex EDM file sequence.

• After hand filing to a size 15, the 10/.05 glide path file was used, followed by EDM OneFile 25.

• Further preparation of the distal canals with a HyFlex EDM 40/.04 finishing file and finishing of the abruptly curved mesial canals with a HyFlex CM 35/.04.

HyFlex EDM Glide Path File 10/.05

‘Thanks to these flexible, fracture resistant files we were able to shape the canals very efficiently. Without pre-bendable NiTi files, we would probably have been unable to perform root canal treatment on this tooth’ Dr. Sam Alborz

Pre-op

Post-op

Scan here to view the Hyflex EDM range on our website

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DR. SAM ALBORZ DDS, Tennessee, USA

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ENDODONTICS SOLUTIONS

HYFLEX REMOVER CASE REPORT THE JOURNEY IS THE REWARD

During a revision, the optimal canal shape is not always that obvious at the start. Fortunately, modern assistance systems guide the dentist step by step through the individual root canal anatomy. In the following case, I will present how I used a new digital endodontic co-pilot to support me in navigating to the apex.

When travelling by car, people have long since become accustomed to employing a navigation system or application. The digital co-pilot knows the traffic rules, reports and avoids obstacles and, in case of doubt, even reacts faster than the human driver. The long-cherished dream of reliable autonomous driving is now apparently finally coming true in endodontics too.

Thanks to a new drive concept, modern endodontic motors provide the dentist with quasi active support in both mechanical and chemical preparation. At millisecond intervals, a complex algorithm controls the variable file movements— current intensity and torque and possible fatigue always firmly in view.

At the same time, the electronic co-driver signals acoustically when and how often rinsing is required.

Such assistance systems are a great help, especially during revisions where the course of the canal ahead

Fig 1

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Fig 2

Fig 3

is not quite obvious at the beginning. This was also the case in a retreatment in the left mandible reported here.

Periapical periodontitis of tooth #36 The 30-year-old patient was first diagnosed with acute pulpitis in a mandibular molar in 2015. Tooth #36 received root canal therapy and was then obturated using the vertical condensation technique with gutta-percha and a two-component sealer (Fig. 1). Unfortunately, the success of the treatment was not long-lasting. In 2020, the patient again presented himself in our practice with acute pain symptoms. Radiographic diagnostics confirmed the suspicion of periapical periodontitis around both root canals of the treated tooth #36 (Fig. 2). The patient finally agreed to the necessary revision treatment.

Preparation with remover file The first and decisive step in retreatment is the complete removal of the inadequate or aged guttapercha filling. For this purpose, we use special remover files in our practice (Fig. 3). The 30/.07 MicroMega REMOVER file (COLTENE) adapts flexibly to the individual canal shape. In this case,

Fig 4

ENDODONTICS SOLUTIONS we loosened the existing obturation material in this way without using additional solvents. At a speed of 1,000 rpm with continuous rotation, the filigree file was inserted into two-thirds of the canal. Thanks to the non-cutting instrument tip, the surrounding dentine was spared as much as possible. This additional safety component has proved to be very valuable in daily work.

Subsequently, the use of suitable nickel–titanium (NiTi) files is recommended for further shaping of the channel. The remaining distal root was treated with the HyFlex EDM OneFile in the contra-angle handpiece at 500 rpm. The 20/.05 HyFlex EDM file was used in the mesial canals. The speed was also 500 rpm. With the remover files, the existing guttapercha could be eliminated surprisingly quickly and easily. Within seconds, a clean access to the apical third was achieved.

To the root in autopilot Even more exciting for us was the test drive with a new type of digital endodontic assistance system.

The CanalPro Jeni endodontic motor (COLTENE) was used for the first time to perform the mechanical and chemical preparation in the case described (Fig. 4). The motor is named after its developer, Dr Eugenio Pedullà. For a long time, the Italian endodontist was occupied with the question of how the concept of autonomous driving could be employed in endodontics for safe and less error-prone root canal therapy. The result is a fully automatic endodontic motor that independently finds its way through the root canal.

The application was comparatively simple: just work steadily with light pressure from the coronal to the apical aspect. Meanwhile, the motor decides independently on the appropriate motion sequence.

For this purpose, the software of the assistance system uses complex algorithms that make the whole thing possible in the first place. Every millisecond, the device controls the variable file movements and continuously adjusts the rotational movement, speed and torque. Unnecessary file

preliminary work in the canal from coronal to apical, since I was used to advancing carefully in a small pecking motion downwards relying on tactile feedback. With Jeni, the dentist just holds the contra- angle handpiece; the motor does the rest and adjusts the rotation to the root canal anatomy.

This “teamwork” also makes root canal therapy much more efficient and less prone to errors. After my initial reluctance, I grew more confident and trusted Jeni to indicate in good time when things could get tricky in the canal. The digital co-pilot also indicates when it is time to change files and when to rinse. In turbulent weeks with many treatments and emergencies, you will be quite grateful to have an additional safeguard in addition to the assistance at the chair to subtly remind you of the next step in the treatment process.

For the final shaping of the canal, the 25/~ HyFlex EDM OneFile was used in the mesial canals. A 40/.04 EDM file was used in the distal canal. The result on the radiograph after obturation was extremely pleasing. Hopefully, it will be more durable than the first treatment approach five years ago (Figs. 5 & 6).

Conclusion During revisions, flexible remover files can be used to efficiently loosen and remove insufficient gutta-percha fillings. Digital endodontic assistance systems navigate the dentist step by step through the mechanical and chemical preparation by adjusting the variable file movement. Thanks to the continuous preprocessing from coronal to apical, canal shaping is much more efficient and less prone to errors than before.

stress is also continuously corrected by Jeni.

The selection of the appropriate NiTi sequence on the touch screen was quick and easy. However, it took a bit of getting used to the consequent

Fig 5

Fig 6

Note: The Jeni is currently not sold in our region

Scan here to purchase the Hyflex Remover on our website

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DR SILVIU BONDARI France

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ENDODONTIC SOLUTIONS

TIME FOR A CHANGE Dental Products Australia

Ready to try an improved calcium hydroxide medicament paste for endodontics?

CALMIX is an endodontic medicament that has a unique composition, ( a first for dentistry ), which is optimised for: •

Higher pH values than can be achieved in aqueous solutions. (CALMIX™ recorded ≥pH14) 1,2.

•

Greater effectiveness against fungi than all other calcium hydroxide pastes. 3

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Broad spectrum effectiveness against highly resistant bacterial species, penetration of biofilms and inhibition of endotoxins. 3,4 ,6

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Release of hydroxide and calcium ions enhanced by a unique, patent-protected solvent. 5

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Excellent biocompatibility for soft tissues – independently Australian lab-tested.

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Optimised viscosity for direct delivery into apical root canal system through ultrafine tips.

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Non-staining formula using zirconium dioxide.

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Enhanced radiopacity for detection on radiographs.

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Improved removability by irrigation – methylcellulose free. 7

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Improved shelf life and won’t dry out – water-free.

History Traditional calcium hydroxide pastes for endodontics date back to the 1920s. These use water as the solvent, to which is added a thickener such as carboxy methylcellulose, and a radiopaque agent. Unfortunately, the low solubility of calcium hydroxide in water limits the maximum pH to 12.7, which further restricts the total release of hydroxyl ions that are responsible for the antimicrobial actions.1,2 Additionally, buffering of the pH by dentine greatly reduces the concentration of hydroxyl ions2,4 and compromises the overall effectiveness as an antimicrobial agent against bacterial species which can survive at highly alkaline pH conditions – up to pH 11.5.6,8

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ENDODONTIC SOLUTIONS

CALMIX™ – Better by design

Clinical Applications

CALMIX™ uses a novel biocompatible solvent to improve the release of Hydroxyl ions.

Use of patented compositions consisting of co-polymerised polyethylene glycol (PEG) as the solvent enables ideal physical and chemical characteristics for clinical use.5 PEG in various forms is used in pharmaceutical products because of its high biocompatibility. It was discovered that optimised formulations of PEG were a superior solvent for calcium hydroxide and could dramatically elevate the pH that could be achieved by actively dissociating the compound into its ionic form.

5 This improved the release of hydroxyl ions by several orders of magnitude compared to water-based formulas.9

Calmix is suitable for use as an intracanal medicament for improved disinfection within areas of the root canal that are not easily accessible or instrumented eg: isthmuses and fins. (Figure 1) Calmix can also be used in vital pulp therapy as a pulp capping agent, and as a long-term dressing for apexification cases. Its enhanced radiopacity allows for easy identification on periapical radiographs and can assist in tracing the root canal morphology on 3D-imaging systems (Figure 2).

Release of ions Hydroxyl ion release from CALMIX™ calcium hydroxide was designed for broad spectrum antimicrobial activity, penetration into biofilms, and effective against recalcitrant bacteria such as Enterococcus faecalis - which is often found in failed endodontic treatment. CALMIX™ has also been shown to inhibit endotoxins, reduce inflammation and dissolve organic tissues.3 When hydroxyl ions are released, calcium ions are also bio-available which contributes to hard tissue repair - essential for pulp capping and apexification – and potentially contributes to the healing of radicular cysts.10 Studies of the release of hydroxyl ions into the dentine of the root have demonstrated that higher pH values are achieved at the root canal walls and through the inner and middle parts of the root with CALMIX™ than with water-based calcium hydroxide pastes.9 Unlike compositions containing water, CALMIX™ can sustain the high pH over long periods of time without relapse, thereby providing a longer therapeutic effect and reducing the need for frequent re-dressing in longstanding lesions. However, the pH recorded on the external root surface is unaffected,11 indicating no adverse chemical effect on the cells of the periodontal ligament and no increase in post-operative discomfort. Calmix has been independently Australian lab-tested using ISO 10993-5 (2009) to be less cytotoxic than other commonly available formulations.

Figure 1: Laser fluorescence imaging shows isthmus area uninstrumented following mechanical instrumentation. Calmix within the canals provide a hostile environment to chemically debride and disinfect areas that are hard to reach. (Image courtesy of Kiran Kumar, Yu-Yao Teoh, Laurence J Walsh)

Figure 2: Enhanced radiopacity allows for easy tracing of canal morphology. 3D imaging showing a middle-mesial canal filled with Calmix for improved contrast and easy identification.

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ENDODONTIC SOLUTIONS KEY POINTS: CALMIX™ •

Independently tested to be less cytotoxic when tested against other calcium hydroxide medicaments.

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Contains zirconium dioxide, a non-staining radiopaque agent.

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Greater calcium hydroxide dissolution and release for higher pH than all other existing medicaments

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Maintaining higher pH over longer periods of time - achieving greater and prolonged antimicrobial activity within the root canal system reducing the need for frequent re-dressing.

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Greater release of calcium ions for hard tissue formation.

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Unique PEG co-polymer composition – no water or methylcellulose – does not dry out on a pad or in the syringe, ready to use with no mixing, and easily flowed into canals with very fine microtips.

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Methylcellulose-free composition is easily removed prior to obturation.

REFERENCES 01

Athanassiadis B, Walsh LJ. Aspects of solvent chemistry for calcium hydroxide medicaments. Materials (Basel) 2017;10:1219. DOI:10.3390/ma10101219 PMID: 29065542

02

Teoh YY, Athanassiadis B, Walsh LJ. The influence of aqueous and PEG400 solvent vehicles on hydroxyl ion release from calcium hydroxide medicaments. Int Dent – Australasian edition. Vol 11, No 4.

03

Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides aantimicrobial medicaments in endodontics. Aust Dent J 2007;52(1 Suppl):S64-S82.

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Athanassiadis B, Abbott PV, George N, Walsh LJ. In vitro study of the inactivation by dentine of some endodontic medicaments and their bases. Aust Dent J 2010; 55:298-305.

05

Australian patent 2012/286596. New Zealand patents 620382, 709691, and 728268. World patent WO 2013013275. European patent application EP 12818358.9.

06

Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J 2002;35:221-228.

07

Chou K, George R, Walsh LJ. Effectiveness of different intracanal irrigation techniques in removing intracanal paste medicaments. Aust Endod J 2014;40:21-25.

08

Walsh LJ, Athanassiadis B. The challenge of endodontic “superbugs” in clinical practice. Australasian Dental Practice 2008;19:102-106.

09

Teoh YY, Athanassiadis B, Walsh LJ. Comparison of commercial calcium hydroxide pastes for prolonged antibacterial effect using a colourimetric assessment. Materials (Basel) 2018;11:348; DOI:10.3390/ma11030348.

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Kontogiannis TG, Tosios KI, Kerezoudis NP. Effect of calcium hydroxide as intracanal medicament on the expression of caspase-9 located within the radicular cyst epithelium. Aust Endod J 2019;45:352-356.

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Cai M, Abbott P, Salgado JC. pH changes in radicular dentine associated with calcium hydroxide and corticosteroid/antibiotic pastes. Aust Endod J 2018; DOI: 10.1111/aej.12280

Order Calmix through our website.

DR YU-YAO TEOH Brisbane, Queensland

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Learn more on Dental Education Hub scan here.

ENDODONTIC SOLUTIONS

KOMET PROCODILE FAST CUTTING BY NATURE

With its completely revised file design, Procodile is a totally new species in the kingdom of root canal preparation. The innovative, variably-tapered file core makes Procodile noticeably more efficient and flexible and, therefore, ideally suited for the perfect shaping of the root canal and a high-quality preparation. Procodile can be distinguished from all other files at first glance by its unmistakable green colored ring.

Hungry: Fast and efficient substance removal.

Thanks to the innovative, variably-tapered file core, the chip space of the Procodile files is increased by up to 12 %*.

Infected tissue is removed even more efficiently from the root canal thereby allowing for optimum preparation time.

Large chip space for perfect evacuation of debris

+44%

Flexible: Optimum preparation even of curved root canals.

Thanks to its variably-tapered core and double-S cross section, the intelligent design of this file offers up to 44 % more flexibility. For this reason, even curved root canals can be prepared in complete safety without alterations of the shape.

Reference product

Adapted instrument core for great flexibility.

* Compared to R6 ReziFlow instruments

Improved flexibility Procodile compared to R6 ReziFlow, based on in-house tests. Supporting data are available.

Fracture-resistant for greater patient safety Compared to other reciprocating file systems, Procodile is up to 120 % more resistant to cyclic fatigue. This decreases the risk of fatigue fracture and increases the safety of the patient. The single-use instruments are supplied in sterile packaging to reduce the risk of possible cross-contamination.

Procodile

Reference product

Procodile

Up to 120% safer

A new movement, adaptable in the EndoPilot Designed for work in all commonly used reciprocating endo motors for an easy-to-achieve and safe performance. That’s not all: Procodile files now perform a new, patented motion in the EndoPilot: Suitable for use in both straightforward and more complex canal anatomies, the intelligent ReFlex movement unites the advantages of rotary and reciprocating motions.

Resistance to cyclic fatigue Procodile files compared to leading competitors, based on in-house tests. Supporting data is available.

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ENDODONTIC SOLUTIONS

PROCODILE RECIPROCATING FILE AGILE, FAST CUTTING, HUNGRY

The clear and concise Procodile system is comprised of 4 main sequences for narrow, medium and wide canals. Each sequence contains a small selection of files for an easier choice and greater clarity. For perfect obturations, we provide matching paper and gutta-percha points.

• Optimum preparation of even curved root canals – thanks to a variably tapered file core • Fast and efficient substance removal – due to an enlarged chip space • Increased patient safety – thanks to greater resistance to cyclic fatigue • Suitable for use in all established reciprocating motors

Option for narrow canals

PR0C6L25.204.020

PPPR06.000.020

GPPR06.000.020

PR0C6L25.204.025

PPPR06.000.025

GPPR06.000.025

PPPR05.000.040

GPPR05.000.040

Option for medium canals

PR0C5L25.204.040

Option for wide canals

PR0C4L25.204.050

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PPPR04.000.050

GPPR04.000.050

ENDODONTIC SOLUTIONS

[ 01 ] Generous preparation of the canal entrance region, for example with the reciprocating Opener OPR08L19.

10000666v001_BRO_EN_Procodile_Endo.indd 1

06.09.19 10:19

[ 02 ] Creation of a glide path for example with a K-file in size 015.

Choosing the matching Procodile file depends on the previously used (manual) file size. General rule: Skip one ISO file size. [ 03 ] Preparation of the canal with the Procodile file. [ 04 ] Obturation with a matching gutta-percha point.

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Komet Available exclusively at Henry Schein

Scan here to view the Komet Procodile Reciprocating File System

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ENDODONTICS SOLUTIONS

BRILLIANT EVERGLOW USER REPORT

COLTENE’s everyday, high performance composite BRILLIANT EverGlow – universally esthetic, simply strong A 33-year-old female with a very minor caries history presented to my service for a restorative treatment plan relative to a progressively “darkening tooth” that she had been noticing over the past few months.

On examination, tooth 46 exhibited a stained fissure system with marked polychromaticity in the tooth, as well as the presence of cavitated occlusal caries (Fig. 1). She did not have any other carious lesions present but did have moderate buccal cervical abrasion lesions from aggressive brushing throughout her life. Tooth 46 was planned for a single shaded direct composite restoration with a smart duo shade resin material, and the chameleon effect of the same material was to be demonstrated during restorations of 44 B and 45 B in the same appointment (Fig. 4).

Case Description The use of minimally-invasive direct restorations is indicated in many clinical situations, from the replacement and/or optimisation of old restorations to dental trauma, abrasion and tooth erosion, through the modification of shapes (conoid, pegshaped, etc.) up to the rebalancing of the smile, both aesthetically and for the presence of rotations and discoloration.

Fig 1: Pre-operative view of tooth 46.

Cavitated pit fissure is evident.

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The patient was anaesthetized using a single carpule of 4 % Articaine with 1:100,000 epinephrine and the lesions isolated using rubber dam (ROEKO Flexi Dam non-latex, COLTENE). Caries was excavated from tooth 46 and caries detector dye used in two sequential washes during the removal process.

The enamel margins were beveled slightly (Fig. 2) before a selective etch procedure using ONE COAT 7 UNIVERSAL (COLTENE), a multi-mode all purpose bonding system. The restoration was constructed using increments to create each individual lobe, starting with the mesiobuccal. Buccal cusps were layered and the lingual facing surfaces stained lightly using a Pink-Orange tint (GC Optiglaze Color Kit) before constructing the lingual cusps, mesiolingual before distolingual. A single shade of the smartcolored composite BRILLIANT EverGlow (COLTENE) was used for the entire restoration, simplifying the procedure tremendously with no compromise in either strength or esthetics (Fig. 3). The cervical abrasion lesions on 44 B and 45 B were isolated, an infinity bevel established and micro-airabraded using 27 micron aluminium oxide in order to maximize surface area for bonding. The lesions were selectively etched before generous application of ONE COAT 7 UNIVERSAL, vigorous air thinning and subsequent curing. The lesions were layered with BRILLIANT EverGlow A3/D3 in alternating cervical-then-incisal increments until the full volume of the restoration was recreated (always judge required resin volume from the occlusal view) (Fig. 5).

Fig 2: Inta-operative view. Carries is fully removed.

Fig 3: Single shade restoration BRILLIANT EverGlow A3/D3. Seamless colour intergration

ENDODONTICS SOLUTIONS 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.

Biography Clarence 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 mostly limited to cosmetic and restorative dentistry. She is wellpublished 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 throughout New Zealand and Australia. Clarence is the Chairperson of the New Zealand Academy of Cosmetic Dentistry. She is an Accreditation Candidate and Sustaining Member of the American Academy of Cosmetic Dentistry and seeks to be the first in New Zealand and Australia to gain Accredited Status with them. Clarence is an Opinion Leader for Henry Schein Shalfoon, 3M ESPE, Kuraray Morita, GC Australasia, SDI, COLTENE, Dentsply/Triodent/ Rhondium and the only Voco Fellow in Australasia.

Clarence maintains a private practice limited to cosmetic and restorative dentistry in Newmarket, Auckland.

Material Description and Rationale for use: COLTENE has developed a product which is aimed at simplifying both the armamentarium and lives of top-tier restorative dentists. The result is a material that can be universally-applied and features a satinlike shine right out of the box and after placement.

This makes polishing a breeze. Shades for the comprehensive system have been designed using the adaptive Duo Shade concept, which covers two VITA shades simultaneously. In my practice, 80 % of adult non-bleaching patients can be treated using the universal shade A3/D3 in this system. The full assortment features only 12 shades (7 universal, 2 translucent and 3 opaque shades) to cover all areas of dental application.

For me, sculptability and ease of modelling is incredibly important in the provision of direct, biomimetic composite restorations. It is a hassle when materials stick to the instrument, or when delicately modelled lobes slump into each other. This material does not do any of that, which makes me smile. It is a non-tacky material that allows easysculpting but at the same time wets the bonded surface very well. The strength, amazing abrasion resistance and esthetics of this material stems from a simple combination of submicron-sized barium glass fillers in combination with some pre-polymerized fillers with low overall water absorption. Each filler in turn has been surface treated to optimize bonding strength and quality, helping your surface stay intact longer than most, especially important in posterior restorations. Compressive strength is impressive at just under 400 MPa and puts this material in the top tier of high-performing posterior restorations. The real kicker is how easy it is to polish relative to the competition and how pretty it will look at your recall exam; if you can tell where your restoration is.

Restoration 2 (teeth 44B and 45B) Fig 4: Pre-operative view teeth 44B and 45B

Fig 5: The lesion were layered with BRILLIANT EverGlow in alternating cervical-then-incisal increments until full volume of the restoration is recreated

Scan here to view the BRILLIANT EverGlow range on our website

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DR. CLARENCE TAM HBSc, DDS Cosmetic and General Dentistry Auckland

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COSMETIC & RESTORATIVE

G-AENIAL A’CHORD THE ADVANCED UNIVERSAL COMPOSITE WITH UNISHADE SIMPLICITY

Simplified unishade G-ænial A’CHORD always delivers more: a simplified unishade system of 5 core shades that achieves the aesthetics of the 16 classic Vita shades with ease. With this reduced inventory, you will save time and costs. Its unique filler technology mimics natural light reflection resulting in impressive invisible restorations.

Invisible aesthetics even for extreme challenges In addition to its 5 core shades G-ænial A’CHORD extends its portfolio with 2 cervical shades for elderly patients, 3 opaque for masking discolouration, 2 enamel for life-like translucency and 2 bleach shades for brighter smiles, thus making it possible to create invisible fillings even for extreme challenges.

Images courtesy of Dr W. Boujemaa, France

Images courtesy of Dr G. Benjamin, Germany

For further information

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COSMETIC & RESTORATIVE

INITIAL LISI BLOCK NEW FOR CEREC

Fully crystallised lithium disilicate CAD/CAM block for chairside solutions To bring fast solutions for one appointment dentistry, GC has further developed HDM technology for CAD/CAM dentistry by optimizing the crystal size and glass matrix stiffness. Thanks to this new technology, good machinability, marginal integrity, polishability, and wear resistance are achieved at the same time. The result is a strong and easyto-mill block that offers the same strength with or without firing.*

Just Mill, Polish and Place Initial LiSi Block can dramatically reduce process time: no need to fire, glaze, characterize 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. You just need to mill, polish and place!

Function Meets aesthetics I’m totally excited about the natural opalescence and color matching of the HT version of LiSi Blocks.

MDT Christian Hannker, Germany

I love the opalescence of LiSi Block and as a consequence thereof the color stability and perfect matching.

Dr. Christian Lampson, Germany

Images courtesy of MDT Christian Hannker & Dr. Christian Lampson, Germany

Images courtesy of MDT Marco Muttone & Dr. Alessandro Iorio, Italy

^ Under testing conditions based on IFU

Find out more

* Source: GC R&D, Japan, Data on file

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COSMETIC & RESTORATIVE

G-AENIAL UNIVERSAL INJECTABLE TRANSFORM THE WAY YOU WORK

World-leading technologies have enabled GC to define a new benchmark composite offering exceptional strength, unsurpassed polishability and fantastic, tooth-blending aesthetics. But you’ll be amazed at how it is injectable and shapeable all at the same time. It adapts perfectly to the cavity floor, but lets you build, shape and contour while you are injecting – because G-ænial® Universal Injectable doesn’t slump! Universal application for all cavity classes, faster placement time with no wastage.

G-ænial® Universal Injectable is also now available in a convenient unitip delivery option.

Clinical applications Class III restorations

Initial class III cavities

Injecting G-aenial Universal Injectable (A2)

Recall situation showing perfect margin integration

Injecting with G-aenial Universal Injectable

Immediate Post Operative

Images courtesy of Dr Ahmed Al-Jaff, Iraq

Posterior Class I restorations

Initial presentation Images courtesy of Dr Ali Salehi, France

Transform

the way you

work

Start injecting with our strongest direct restorative ever*

G-ænial® Universal Injectable

Find out more

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COSMETIC & RESTORATIVE

EVERX FLOW FIBRE-REINFORCED FLOWABLE COMPOSITE

Where core strength matters everX Flow is a highly fracture tough, reinforcing composite substructure incorporating unique micro-fibre and full silane coverage technologies. To help you achieve stronger and more durable posterior restorations, place everX Flow as a dentine replacement under composite or use as a core under indirect prostheses.

The biomimetic restorative technique, using SFRC (short fibre-reinforced composite) substructures, can be used routinely for coronal restorations and teeth with large cavities in high stress-bearing areas.*

Clinical observations

Images courtesy of Dr Georg Benjamin, Germany

Extensive preparations, including missing cusps and amalgam replacements

Images courtesy of Dr Rudolf Novotny, Slovakia

Class II preparations

Images courtesy of Dr Lucile Dahan, France

Endodontically-treated teeth

Introducing the power of fibres

everX Flow Fibre-reinforced flowable composite – where core strength matters.

To view more on everX Flow scan here

*Garoushi S, Gargoum A, Vallittu P, Lassila L. Short Fiwbre-reinforced composite restorations: A review of the current literature. Dental Biomaterials 2018

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COSMETIC & RESTORATIVE

KATANA ZIRCONIA THE SCIENCE BEHIND SUPERIOR PRODUCT PROPERTIES

Users of dental zirconia are really spoilt for choice these days. Countless manufacturers offer zirconia materials that differ in their mechanical and optical properties and indication range.

What is not apparent at first sight is that the available products also differ with respect to the quality of the CAD/ CAM blanks offered. Blank quality is highly dependent on the quality of the raw materials and is affected by different aspects during raw material processing, pressing and pre-sintering.

This has a huge impact on the surface quality, edge stability, fit and processing requirements of milled restorations.

Raw material production Pre-shaded dental zirconia typically consists of metal

oxides, including zirconium oxide, yttrium oxide and aluminium oxide, as well as additives like binders and colour pigments or ions. Most manufacturers of dental zirconia obtain pre-fabricated powder from an external industry partner, the most popular option being Tosoh Corporation. In contrast, Kuraray Noritake Dental relies on an end-to-end in-house process. This includes the production and addition of the components forming the company’s innovative multilayer technology for a polychromatic blank structure and – in the case of "KATANA™ Zirconia" YML – additional translucency and flexural strength gradation.

properties to achieve a smooth transition from one layer to the next. The result is a seamless colour structure and outstanding match of the shades in the polychromatic blanks to the colours of the VITA classical A1–D4 shade guide. In those materials combining different yttria concentrations in a single blank, additional in-house alignment measures may be taken. In the case of "KATANA™ Zirconia" YML, a completely new raw material was developed to deliver a uniform shrinkage ratio and harmonized coefficients of thermal expansion across the blank and thus bring flexural strength gradation to perfection.

Properties of zirconia restorations that are affected by the powder quality and composition include translucency and shade appearance, flexural strength, ageing behaviour and sintering performance.

Blank pressing

At Kuraray Noritake Dental, the powder is produced in-house.

Since more powder production steps are carried out in-house, the company is given full control over the quality of the raw materials, their grain size and the purity of the formulation. It also allows for a precise alignment of the mechanical and optical product

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Zirconia discs and blocks used for CAD/CAM processing are usually produced by uniaxial and isostatic pressing. In the uniaxial compaction process, pressure is applied to the powder from one direction (uniaxial) or two directions (biaxial), whereas the isostatic compaction process involves virtually equal pressure applied from all sides.

Hence, isostatic pressing typically results in a more uniform density distribution throughout the blank and a higher material homogeneity. These factors are prerequisites for a predictable processing and sintering behaviour and affect the fit of the final restoration. For optimal mechanical and optical

Image: DT Giuliano Moustakis

COSMETIC & RESTORATIVE

A “KATANA™ Zirconia” blank ready for milling

properties of the zirconia material, it is essential to avoid large porosities, air pockets and impurities caused by airborne particles that are trapped during pressing.

sintered state. Although more stable, pre-sintered "KATANA™ Zirconia" is machinable with common diamond-coated milling tools without any increased risk of breakage or higher tool wear.

At Kuraray Noritake Dental, a unique and extremely meticulous pressing process achieves a uniform pressure distribution and low risk of contamination by airborne particles. This specific procedure reduces gravitation forces and contributes to having as high as possible density of zirconia material.

All the high-level preparation processes from raw material production to pressing are responsible for the high edge stability and surface quality of restorations milled from "KATANA™ Zirconia".

Fast sintering for the laboratory The unique procedure has a positive impact on the surface smoothness after milling and can significantly shorten sintering times. In the dental laboratory, the sintering times may be reduced to 54 minutes* for single-tooth restorations and bridges of up to three units – an interesting option for rush cases and remakes. * The material is removed from the furnace at 800 °C.

Pre-sintering The pre-sintering procedure is necessary in that it gives the pressed blanks the required stability to be machinable with milling tools. The selected temperature profile and duration of the pre-sintering cycle determine the material’s strength and processing properties and have an impact on the final sintering process.

“KATANA™ Zirconia” YML

Discs of major competitors*

“KATANA™ Zirconia” YML speed sintered (90-minute sintering schedule), whereas the discs of competitors were sintered using typical overnight sintering schedules suitable for the particular material. Even with 90-minute sintering, KATANA™ Zirconia YML displays superior optical properties when compared to major competitors.

The unique pre-sintering procedure carried out in the production facilities of Kuraray Noritake Dental results in blanks that are stable in their pre-

Uniform sintering schedules are offered for the whole "KATANA™ Zirconia" Multi-Layered Series.

20OC Start

800OC

800OC

20OC Start

1600OC

1560OC

-10OC/min 153 min

20OC Start

-120OC/min 6.7 min

-50OC/min 15.2 min

+120OC/min 11.9 min

+50OC/min 27.6 min

+10OC/min 153 min

HOLD

16 min

7H

90min*

1450OC

54min* HOLD

1560OC

+10OC/min 15 min

1400OC +4OC/min 25 min

HOLD

120 min

1550OC

20 min

+10OC/min 6 min

1550OC

1500OC 1600OC

Overview of the recommended sintering protocols.

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COSMETIC & RESTORATIVE

Fast sintering for chairside

Unique “KATANA™ Zirconia” properties

Using the “KATANA™ Zirconia” block with Dentsply Sirona’s CEREC system, it is possible to sinter single crowns up to three-unit bridges in 18–30 minutes without compromising the mechanical or optical properties.

Together, these efforts taken by Kuraray Noritake Dental to produce dental zirconia of high quality make all the difference. The “KATANA™ Zirconia” series— “KATANA™ Zirconia” Yttria Multi Layered (YML), Ultra Translucent Multi Layered (UTML), Super Translucent Multi Layered (STML), High Translucent Multi Layered Plus (HTML Plus) and KATANATM Zirconia High Translucent Mono Layered (HT)—have a homogeneous, high-density structure with low porosity and a high level of purity.

In addition, “KATANA™ Zirconia” YML offers a seamless structure without transition lines despite flexural strength gradation. All these properties optimise the performance of the blanks during machining.

The “KATANA™ Zirconia” block displays superior optical properties after 18 minutes of sintering compared with representatives of major competitors’ raw material after 30-minute and 60-minute sintering programs designed by Kuraray Noritake Dental based on the manufacturer’s recommendations.

KATANA™ Non Polished

C - Non Polished

SEM images of non-polished “KATANA™ Zirconia” and a competitor’s material at 33× magnification.

The four images of each material show the surface structure at different areas of a molar crown. In all areas, the surface of the restoration made of the competitor’s material is rougher and shows more porosity than the surface of the “KATANA™ Zirconia” crown directly after milling, according to Dr Josef Kunkela’s research results.

One of the contributing factors to this result is the more densely pressed blanks with smaller grain sizes of “KATANA™ Zirconia”.

(Courtesy of Kunkela Research Academy by Dr Josef Kunkela)

Surface roughness An optimised processing behaviour leads to regular restoration margins, smooth surfaces and a precise fit of the restorations. The latter is due to the fact that the milling behaviour and volumetric shrinkage during final sintering are highly predictable, so that a user designing a 20 µm cement gap will get what

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he or she desires. Owing to the great control over optical properties and outstanding match to the VITA classical A1–D4 shades, "KATANA™ Zirconia" is considered to be one of the most aesthetic dental zirconia options available on the market.

COSMETIC & RESTORATIVE

Excellent marginal fit

“KATANA™ Zirconia” STML Block / Primemill - 19-21µm

Lithium Disilicate / Primemill - 26-45µm

SEM images revealing the fit of restorations made of two different materials (lithium disilicate and “KATANA™ Zirconia” Block STML) on a tooth abutment.

The “KATANA™ Zirconia” restoration shows a more regular margin and more precise fit (with a cement gap of 19–21 µm) than the lithium disilicate crown (cement gap 26–45 µm). (Courtesy of Kunkela Research Academy by Dr Josef Kunkela)

100µm

Extremely regular margins of a “KATANA™ Zirconia” crown after milling, which is also a result of the favourable material structure.

In order to ensure all the desired material properties, including aesthetics and strength, one thing is essential: the machining carried out in the dental laboratory - milling and sintering needs to adhere to the recommended protocols.

This means that the milling machine and furnace

should be cleaned and calibrated on a regular basis, which provides the conditions for optimised zirconia processing from the powder to the final, true-to-life dental restoration.

MATHIAS FERNANDEZ Y LOMBARDI EU Scientific Manager Dental Ceramics & CAD/CAM Materials Kuraray Europe GmbH

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COSMETIC & RESTORATIVE

LUNA 2 THE VERSATILE DENTAL RESTORATIVE FOR EVERY DENTIST

Restorative dentistry is a blend of art and science. One of the most important choices for a dentist is their choice of preferred restorative. Apart from being easy to use, the restorative must look fantastic under a critical patient eye – and stoically stand the test of time for years to come. Your choice of universal composite is critical to the health and endorsement of your patients. Both in the short term and the long term.

A new innovative universal composite from Australia has the potential to fulfill all your clinical requirements.

Luna 2 (SDI Limited) is a new BPA free universal composite - which is a significant advantage for health-conscious patients. Bisphenol A (BPA) is an organic compound used in materials utilized in several industrial and health fields, including many dental composites.

An increased release of BPA can lead to the absorption into oral and gastrointestinal mucosa with high risks of local and systemic toxicity.1 Luna 2 comes as the solution to this problem.

But being BPA free is just one benefit. Over 100 dentists worldwide have already used Luna 2 clinically through a special pre-release conducted by SDI. These clinicians have lauded the handling, shade matching and polishability of Luna 2, confirming that Luna 2 will have a strong future.

Feedback received from these professionals showed that the composite delivers ease of sculpting, non-sticky consistency, excellent polish, very high radiopacity and reliable mechanical properties.

Luna 2 also makes shade matching effortless.

Attaining an accurate shade match can be a complex process. It is also the greatest source of frustration for clinicians and patients.2 A poor shade selection is usually linked to a poor value (the colour lightness) selection.3, 4 To improve shade selection accuracy, Luna 2 includes Logical Shade Matching Technology and the Chameleon Effect.

In developing Luna 2, the SDI scientists prioritised shade value and arranged pigments in a logically increasing way. This approach streamlined the shade development for a simpler and faster match to the Vita Classical Shade Guide®.

Images courtesy of Dr Jiovanne Neri - Brazil

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COSMETIC & RESTORATIVE

The Luna 2 formulation also mimics lifelike translucency, opalescence, and fluorescence.

This means that Luna 2 gives you consistently predictable and more accurate aesthetic results.

Translucency in different thicknesses of Luna 2 shade A2

But what about mechanical properties?

Luna 2 does not disappoint, offering a high compressive strength of 360 MPa to support robust masticatory forces and a very high flexural strength of 130 MPa to reduce failure risk in areas of high stress, by mitigating tensions of compressive forces.5

precise visualisation for diagnosis assistance.

Luna 2 is available in syringes and complets (single dose), in 12 shades, including one incisal, two opaques and two extra bleach shades. As if that wasn’t enough, Luna 2 harmoniously blends with Luna Flow, the new SDI universal flowable composite.

Luna 2 also provides excellent radiopacity of 250% Aluminium, allowing clear differentiation for easy and

References

https://www.researchgate.net/publication/347993804_Color_ and_Shade_Matching

An integrative review on the toxicity of Bisphenol A (BPA) released from resin composites used in dentistry. Lígia Lopes-Rocha,Lara Ribeiro-Gonçalves,Bruno Henriques,Mutlu Özcan,Maria Elizabeth Tiritan,Júlio C. M. Souza. First published: 08 April 2021 1.

Analysis of variables that can interfere with tooth colour.

Masters dissertation. Bernadete Rodrigues do Amaral & Edson Dias da Costa Junior. University of Brasilia, Brazil, 2006.

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Achieving the predictable composite resin restoration: the nature of colour. David Klaff. INTERNATIONAL DENTISTRY SA VOL. 12, NO. 2 4.

https://www.researchgate.net/publication/350755430_An_ integrative_review_on_the_toxicity_of_Bisphenol_A_BPA_ released_from_resin_composites_used_in_dentistry 2.

The Evaluation of Flexural Strength of Composite Resin Materials with and without Fibre. Mustafa Gundogdu et al (2014), Dentistry Vol 4 Issue 9 1000259 5.

Color and Shade Matching. S. Monala; S. Narayanaswamy.

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COSMETIC & RESTORATIVE

GEMINI™ LASER PLAYING A VITAL ROLE FOR BOTH HYGIENE & DENTAL

When patients hear the word “laser” spoken by their clinician, they may become understandably concerned if they have not previously encountered this technology. However, the versatile device can help provide virtually painless treatment for a wide range of indications.

For many dentists and hygienists, Ultradent’s Gemini™ 810 + 980 dual-wavelength soft-tissue diode laser has served to make practicing easier and patients healthier. That’s been the case for Katelin Johnson, RDH, who uses the laser for hygiene procedures at Your Smile Dental in Lindenhurst, NY. Having practiced with other lasers in the past— and being a fan of Ultradent products such as the Opalescence whitening family—Johnson jumped at the chance to adopt the Gemini laser, which she has found to be easy to use with immeasurable benefits for her patients’ oral health. “This is my favorite brand,” she said.

“I use it every single day.”

In many cases, she does need to reassure patients before using it. “Some patients are scared, but I assure them that no numbing is even required,” she said.

“The procedure is very fast and usually pain-free.”

Dr. James Merrett and his team at Hollywood Park Dental in San Antonio, TX, have been using the Gemini laser for 3 years, so he has experience with alleviating patients’ worries as well.

“The usual questions are: Will it hurt? What can I expect after treatment?” shared Dr. Merrett. “I think most patients have a fear of pain. I explain that this is not like the movies and the laser does not shoot out or cut like a lightsaber.”

Procedure Versatility

Johnson uses the Gemini laser for bacterial reduction, particularly on patients with gingivitis and periodontitis.

She finds the procedure to be quite simple.

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“All of the settings are already labeled, which makes the laser extremely easy to operate.” Katelin Johnson, RDH “Getting rid of hard-to-reach bacteria with a precise laser gives patients a head start on ac hieving health goals, including better breath,” said Johnson.

“Removing harmful diseaseaccelerating bacteria colonies quickens healing and slows the gum disease process.”

Having seen amazing results with patients who have special needs, who have undergone chemotherapy or have heart conditions or diabetes, Johnson underscored the benefits of laser bacterial reduction.

“The subgingival environment is changed for 2 whole months, which motivates patients and helps them perfect their hygiene habits and understand how bacteria works,” she said. “The bacteria do not become resistant to the treatment and there is very little chair time as well.”

Johnson also treats cold sores and aphthous ulcers with the Gemini laser. “Educating patients on how the laser reduces bacteria and treats other issues makes them realize that there are more structures in the mouth to address than just the teeth themselves,” she explained.

COSMETIC & RESTORATIVE What makes the Gemini stand out?

Features of the Gemini Laser

First impressions are everything, and Johnson believes the high-tech appearance of the Gemini laser is a conversation starter on its own.

The Gemini 810 + 980 diode laser proves itself a workhorse in any practice with the help of its key features: • 20 watts of super-pulsed power means faster, smoother cutting • Sleek, innovative design features a transparent electroluminescent display • Simple user interface and 20 preset procedures in 980nm and 21 in 810nm, including pain relief • Bluetooth foot pedal for wireless control • Autoclavable handpiece makes sterilisation simple • Single-use bendable tips are preinitiated for reduce prep time • Tip illumination provides better visibility at the surgical site

It consists of a screen made of glass with a stunning transparent electroluminescent display and a sleek base.

“I am a big fan of the screen,” noted Dr. Merrett, who uses the Gemini laser for troughing, gingivectomies, implant recovery, and frenectomies. “The esthetics of the machine are very impressive.”

The laser has 20 preset procedures in the 980 and 21 in the 810 nm wavelength, including a Pain Relief setting.

“All of the settings are already labeled, which makes the laser extremely easy to operate,” Johnson noted.

Dr. Merrett also lauded the preset options.

“I like that it’s broken down into generaI dentistry, orthodontics, and hygiene,” he said. “I also love the option of choosing dual wavelength or single wavelength.”

For Johnson, the Gemini laser stands out over the lasers she used at her former practices for a number of reasons. “With previous lasers, I had to cut, peel, aim, and shape the laser between every patient, which was frustrating and time consuming,” she said.

“Luckily, the Gemini laser has single-use prepared tips, which eliminates this challenge.”

The PBM Adapter Kit

Having a cordless Bluetooth pedal and the ability to recharge the laser has been a bonus for Johnson as well. It makes the technology portable so that clinicians can take it to the patient instead of being limited to one room for laser procedures.

A Surefire Practice Builder

While the laser can play a key role in a variety of procedures, it also can serve to boost revenue for the practice. “Most people are impressed that we have a laser,” said Dr. Merrett. “While there is an added cost for some procedures, we build the value of the laser to the patients, so they typically do not reject it due to cost.”

Johnson said cost is an issue for some patients, but she does many procedures with the Gemini laser every day and it helped her build a successful hygiene department.

The Gemini PBM Adapter Kit allows clinicians to offer pain management therapy during a laser procedure through photobiomudulation (PBM).

Training the Team

The most important factor to consider with any new product or piece of technology in your practice is proper training. “Practicing is essential, and I think practicing your technique on other things before you take it to the mouth is important,” shared Dr. Merrett.

“Two of my hygienists said that using the laser was very easy due to their use of the presets on the laser as a guide, as well as the hands-on training they received before seeing patients.

Light energy is absorbed at a cellular level, Improving circulation, oxygenation and enzyme activity.

They didn’t have any challenges.” No matter the procedure, the Gemini laser serves to provide a smooth and easy experience for the patient while boosting efficiency in the practice.

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PREVENTATIVE SOLUTIONS

SYLC NOVAMIN THERAPEUTIC EFFECTS UNDER THE MICROSCOPE

A: Dentine before air-abrasion.

Note a smear layer-free surface with many patent dentinal tubules.

B: Dentine treated using AquaCare and Sylc bioglass.

Note the presence of a smear layer occluding the dentinal tubules and covering the entire dentine surface.

C: Dentine treated using AquaCare with Sylc and conditioned with a universal adhesive in self-etching mode.

Note that smear layer partially covering the dentine surface; a Bioglass-rich smear layer is still available for conversion into apatite at the resin-dentine interface.

However, most of the dentinal tubules are totally occluded; the risk for postoperative sensitivity here is very low.

Please scan here to view the Sylc Case Study

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PREVENTATIVE SOLUTIONS

GOING GREEN HOW CAN WE AS DENTAL PROFESSIONALS MAKE OUR PRACTICE MORE SUSTAINABLE?

According to the Australian Government’s Department of Industry, Science, Energy and Resources, Australia generated 67 million tonnes of waste in the year 2016-2017 (Australian Government 2020). Dental care, both at home and in the clinic can be seen to produce significant levels of single use waste. With global waste levels rising, what strategies can we as dental professionals implement to decrease the level of landfill associated with oral health care?

Sustainably and minimally packaged oral health products Sustainably and minimally packaged oral health products have now increasingly become available across supermarkets, pharmacies and in dental practices. Materials commonly used in these products include, bamboo, for example, bamboo toothbrushes, and it is of note that companies like Colgate use sustainably grown bamboo. Cardboard is another example, you can opt for your patient take-home packs to be made from cardboard, which can be recycled, rather than single use plastic bags. It is also great to see so much innovation in the recyclable plastic space, in fact, the first fully recyclable toothpaste tube has been launched by Colgate.

Additionally, Colgate is sharing this technology with all other companies - they believe it’s that important.

They state “It’s [the recyclable tube] 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” Each of these materials and innovations, help in reducing the amount of single use waste that arises from at home dental hygiene practices. These products can be advocated and used within your workplace to empower patients to join the movement in helping to reduce waste.

Clinical Practice Multiple use clinical equipment can be a fundamental strategy for your workplace to reduce the waste from single use products. Re-processable metal instruments, patient cups, digital x-ray films, and other clinical equipment that can be sterilised and reused ongoing should be strongly considered. Electronic patient records and communications can help to enable practices to aim for paperless operation.

Careful organisation and treatment protocols involving all staff can significantly help in ensuring that the equipment set out for each patient is dispensed

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appropriately and only what is required for the appointment is used. This can help in reducing the changing of PPE by assistants during examinations and treatments also. Not only is our main goal to drive the message of dental disease prevention to our patients to empower them to improve their oral health but, less disease incidence can result in less materials and waste generated from clinical treatments. A winwin for both patient and clinician!

Colgate’s Terracycle program Another strategy you can implement is getting your workplace to participate in Colgate’s Terracycle program. The program is a voluntary, opt-in initiative developed through a partnership between Colgate and Terracycle. The program is entirely free for dental clinics to participate in, providing shipping boxes and allowing anyone to drop off used oral health products of any brand that would otherwise be sent to landfill.

Such products include toothpaste tubes and caps, manual toothbrushes, electric toothbrush heads, toothbrush and toothpaste tube plastic packaging and floss containers. Electric toothbrush handles and bases can also be recycled but through a separate program here. Once the recycled products are collected at the dental clinic, they can then be sent off to be recycled.

Each unit received collects points which can be redeemed for a monetary donation to a not-for-profit organisation or school of your choice. At present there are over 6,000 participating locations across Australia recycling close to 650,000 units of used oral care products and raising over $10,500. The recycled waste is then processed and used in making a range of products such as garden beds and benches for schools (just to name a couple!).

WILLIAM ‘CJ’ CARLSON-JONES South Australia

PREVENTATIVE SOLUTIONS

OPTIC WHITE LIGHT UP KIT FAQ

the device, patients can simply go to sleep. The serum on the teeth will continue to work overnight as they sleep. Patients will repeat this process once a day for 5-10 days, depending on desired shade change. There is no need to make custom trays.

What is the new Optic White Professional Take Home kit?

Optic White Professional Take Home Kit is a combination of two breakthrough Colgate technologies, that synergistically provide a comfortable and effective whitening experience.

The Precision Pen contains a whitening serum that dries into a concentrated hydrogen peroxide film and is designed for no tooth sensitivity, no gum irritation, and no mess. The LED Device accelerates whitening with 410 nm wavelength of light for faster, better results.

Does the device come in different sizes?

The LED whitening device is designed to fit most patients comfortably, and there is no need for multiple sizes.

Does my patient have to use it 10 days in a row?

How is this different from other professional take-home whitening systems?

Patients will see results after 5 days, however, to get the maximum whitening benefits from the take-home whitening system, it is recommended that patients do all 10 treatments over the course of 10 consecutive days.

The differences start with the formula, a hydrogen peroxide serum, dispensed through a precision pen, allowing a targeted application of the whitening solution.

Once applied, the serum quickly forms a smudge-proof, concentrated hydrogen peroxide film on your patient’s teeth for enhanced whitening. The LED device then uses indigo light energy to amplify the whitening power of the concentrated film even further. Our unique light technology contains approximately 700 or more LED diodes that give off a very specific light in the range of 410 nm wavelength (Indigo). This is a shorter wavelength compared to other systems, and therefore delivers higher, longer lasting energy that helps accelerate whitening. This synergy between the formula and the device allows for whiter, brighter teeth in just ten minutes a day. 10 minutes a day for 10 days. Use as Directed.

What is the device’s warranty?

The device comes with warranty against defects for 2 years.

What is the Optic White Professional Take Home kit shelf life?

Optic White Professional Kit Take Home does not need to be refrigerated and has a shelf life of 2 years.

Can patients use any hydrogen or carbamide peroxide whitening gel with this device?

No. Optic White Professional comes with a specially formulated serum for the device that has a synergistic effect for whitening, different from our previous Optic White Professional version, and should only be used with the Colgate Optic White Professional Whitening Serum.

What type of whitening products are available to the profession with this technology?

Currently we only offer a take home kit. However, we are planning on having an in-office option, available soon, watch this space.

How long does the treatment take?

The treatment takes approximately 10 minutes each day. Just before bed, your patient will apply a single thin layer of serum to each tooth and wait for a clear coating to form, this is usually around 10 -15 seconds.

From here, they will use the LED device, which is designed to be used for 10 minutes per day. Once each treatment is over, the device will beep twice, and the power button will automatically turn off. After removing

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PAIN CONTROL SOLUTIONS

ALVEOLAR HEALING WITH ALVEOGYL

Summary Male patient with longitudinal fracture of tooth 13 that was impossible to restore. The tooth was indicated for extraction and the patient was informed about the possibility of performing a bone regeneration immediately after extraction; the patient refused a treatment. We proceeded to perform an atraumatic extraction and follow a dry socket prevention protocol.

Introduction Alveolar healing is a predictable and safe process, however there are situations which jeopardize the integrity of the alveolus and its future healing. Among the most common post extraction complications is a dry socket or alveolitis (2), a situation caused by the lack of bleeding and the lack of formation of a goodquality clot.

Dry socket is a condition that causes intense and acute pain in the area where the extraction was performed (5). Its etiology is the exposure of bone that could not be covered with granulation tissue due to inadequate bleeding. On average, the pain that the patient reports is on the third day after the procedure and is often treated as a dental emergency.

The treatment consists of inducing bleeding in the alveolar bone to ensure the formation of a clot. In addition to this, aids are used such as collagen-based hemostatics, surgical cements, or hemostatic fibrous matrices, the latter better known as the Septodont brand Alveogyl. In addition to being used as a curative, the indications for Alveogyl have been broadened to include hemostasis immediately after performing the dental extraction. (3) The following publication presents a clinical case using Alveogyl to prevent alveolitis.

Case presentation A 55-year-old patient presented for consultation with the reason given as “my tooth has fractured, and it needs to be removed.”

The patient was clinically examined, and it was observed that tooth 13 was fractured, compromising the integrity of the rest of the tooth and its stability inside the alveolus.

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The extraction was performed a traumatically in order to avoid rupturing the cortical layers and damage to soft tissues (fig. 1). After this, adequate bleeding was verified so that an instrument to induce bleeding in the bone was not necessary. A small amount of Alveogyl was placed inside the alveolus to maintain hemostasis (fig.2). There are Penghawar fibres among the material components, and they generate a network in which fibrin will form the initial clot. The fibrous structure provides the ideal environment for a strong and highquality clot, preventing the appearance of alveolitis (1).

The instructions given to the patient focused on avoiding dislodging the Alveogyl prematurely. In some instances, Alveogyl can remain for more than a week and be uncomfortable for the patient. It doesn’t irritate the new tissue, however, and the only reason to return to the practice is to remove fibers which haven’t been eliminated. The patient was prohibited from using cleaning items such as toothpicks, swabs, or a toothbrush in the extraction area as these might damage the clot formed and even dislodge it (4).

Although Alveogyl was initially indicated to treat alveolitis, its bioadhesive properties mean that it can be used in post-extraction sites.

During the 7 day post-operative check-up, we observed that the fibrin layer created by the body was thick and stable, the surrounding tissues showed no signs of inflammation or irritation (fig. 3), and the patient reported no pain or discomfort. It is necessary to clarify that these procedures were not orientated toward a major bone regeneration greater than that which the body will perform.

PAIN CONTROL SOLUTIONS

Fig. 1: the alveolus presents an adequate amount of bleeding to form a clot.

Fig. 2: the Alveogyl fibers stabilize the clot and avoid exposing the bone.

Fig. 3: during the 7-day check-up, we observed stable tissues and the thick fibrin layer. Excess fibers were removed.

Conclusion The use of dressings like Alveogyl helps encourage good quality healing, avoiding post- operative complications such as alveolitis and reassuring the patient as to the progress of their treatment. Establishing good alveolar healing improves the patient’s condition for a future prosthetic reconstruction. This increases the probability that a patient will accept future treatments to help bring back their masticatory function.

It is important to talk to the patient before carrying out the extraction because this procedure does not get rid of the problem. On the contrary, it creates another problem which is the absence of teeth and limited functioning. With proper planning, a good diagnosis, and planned future treatments, patients will be more aware of the importance of rehabilitation after a dental extraction.

About Dr. Paul Franco Dental prosthesis technician, University of Guadalajara. Dental Surgeon, University of Guadalajara.

Specialist in Periodontics, University of Guadalajara.

Fellow at the University of Texas A&M, Baylor College of Dentistry.

Qualified in periodontal microsurgery by TecSalud, Tecnológico de Monterrey, Monterrey campus.

Publications in the Mexican Review of Periodontology on the use of Chitosan. Member of the Mexican Association of Periodontology.

Member of the College of University Dentists of Jalisco. International conference speaker.

Private practice focused on microsurgery and aesthetics.

References 1.

Supe NB, Choudhary SH, Yamyar SM, Patil KS, Choudhary AK, Kadam VD. Ann Maxillofac Surg. Efficacy of Alvogyl (Combination of Iodoform + Butylparaminobenzoate) and Zinc Oxide Eugenol for Dry Socket. 2018 JulDec;8(2):193-199.

2.

Dallaserra M, Poblete F, Vergara C, Cortés R, Araya I, Yanine N, Villanueva J. J Clin Exp Dent. Infectious postoperative complications in oral surgery. An observational study. 2020 Jan 1;12(1):e65-e70.

3.

Helei VM, Zhero NI, Helei NI, Kryvanich VV. Wiad Lek. Choice of the treatment method of the inflammatory process in the alveolar tooth socket. 2019 Oct 31;72(10):1957-1960.

4.

Saghiri MA1,2, Asatourian A3, Sheibani N1,2. Angiogenesis and the prevention of alveolar osteitis: a review study. J Korean Assoc Oral Maxillofac Surg. 2018 Jun;44(3):93-102.

5.

Mamoun J1. Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques. J Korean Assoc Oral Maxillofac Surg. 2018 Apr;44(2):52-58.

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PAIN CONTROL SOLUTIONS

WHY TOPICAL ANAESTHETICS GO HAND-IN-HAND WITH PATIENT (& PROFESSIONAL) SATISFACTION

Summary Dentists know that pain is a crucial factor in the patient experience. Pain-free patients are satisfied patients and, in these challenging times, that matters more than ever. Local anaesthetics and minimum-trauma needles are commonplace in the dental practice, but despite their wide range of applications and excellent safety profile, topical anaesthetics are not. Are dentists missing a key pain management lever? Here, we make the case for providing every patient with topical anaesthesia.

An effective, but underused, pain management tool Patients consistently cite pain as one of their main concerns about receiving dental treatment. In a survey

by Dental Law, 42% of patients said the fear of pain was the aspect they most disliked about visiting the dentist. In the UK, 36% of people are believed to suffer from dental fear or anxiety and a further 12% have a dental phobia, with pain believed to play a significant role.

Dentists are very conscious of this and recognise the need to manage their patients’ pain.

When interviewed by Septodont, a cohort of dentists from across the United States and Europe rated the importance of anaesthesia as 9.4 out of 10. Pain-controlled patients, they told us, are more relaxed, easier to treat, more likely to return, and more likely to recommend the dentist to others.

Despite this awareness, it seems that dentists are missing a golden opportunity to provide a pain-free, satisfying treatment experience: topical anaesthetic.

Topical anaesthetic is used to numb oral tissues prior to dental treatment. Affecting the superficial mucosa,

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it can reduce the sensation of pain while conduction or infiltration anaesthesia is administered by injection.

It can also facilitate treatments like root planing in the presence of inflammation, or superficial submucosal abscess incision, among many other applications.

When used as a pre-injection anaesthetic, for example, products like Septodont’s Xylonor Spray, X’Ogel or Projel-20 are fast-acting and effective with an excellent safety profile. This seems like an easy win for both the patient and the dentist. And yet, only a third of the dentists we interviewed said that they used topical anaesthesia before giving the patient an injection. In one country, topical anaesthetic was given to only 7% of patients.

The case for universal topical anaesthetic use As we emerge from an incredibly damaging pandemic, many dentists are struggling to stay financially viable. Now more than ever, each product used in the operatory must earn its place.

Topical anaesthetics, it could be argued, are an expense that should be reserved for only the most exceptional cases.

While that’s a valid concern in these difficult times, it fails to take into account the long-term business benefits to be gained from providing a pain-free experience for every patient.

PAIN CONTROL SOLUTIONS with 74% of those mentioning pain or discomfort, and 84% feeling anxious about visiting the dentist again.

It only takes one difficult experience to colour future interactions, so it’s worth pre-empting this with proactive, universally applied pain management.

Anxiety aside, even your most resilient patients will judge you on their pain experience. Patients assess their satisfaction with providers based on a number of criteria, with more than half of them relating to pain management.

While your patient may not be distressed in the chair, that doesn’t necessarily mean they’re satisfied. And it’s not always logical when pain is involved; even if the patient understands on a rational level that you’re only trying to help, you are ultimately the source of their pain and thus, the target of their frustration.

An unsatisfied patient is less likely to comply with your recommendations and more likely to delay future dental care, leading to more complicated treatment needs and poorer outcomes down the line. If the patient is particularly unhappy, they may switch providers or share their experiences with others. As is the case with dental anxiety, this can be pre-emptively managed with a simple act of care in the form of topical anaesthesia.

Pain, anxiety and no-shows – the missed connection The dentists we surveyed identified two types of patient that impacted their business. The anxious patient takes longer to treat, is less likely to return, and may harm the business via word-of-mouth. The no-show leaves a gap in the schedule that can’t be filled, interrupting workflow and losing the dentist money. Both, dentists said, caused them to feel stressed and demotivated at work.

Interestingly, dentists didn’t make much of a connection between the two. They estimated that only 7% of their no-shows were due to patient anxiety, but the Dental Law survey indicates that this number is far higher. 28% of respondents, they report, claimed to have cancelled or missed appointments due to anxiety.

Some dentists forgo topical anaesthetics because they believe that, with the right needle in skilled hands, they can deliver almost painless injections.

While that may be the case, it offers little comfort to anxious patients.

The expectation or anticipation of pain can be almost as traumatic – sometimes worse – than the pain itself, motivating some patients to delay or avoid treatment. In the case of injections, research shows that anxiety can intensify the patient’s perception of pain during the injection. This creates negative expectations for future treatment, reinforcing the anxiety-pain connection.

The bottom line Just as we emphasise preventive care over reactive treatment, we must take a preventative approach to pain management and patient satisfaction.

We must also keep in mind that, if some patients delay or miss treatment due to their fear of pain, we won’t always be aware of their anxiety or have the opportunity to manage it – but we will still be very much affected by it. With that in mind, any opportunity we do have is one that shouldn’t be missed.

Offering a topical anaesthetic is a simple way to break this connection. Patients are more likely to show up if you can assure them that the injection – not just the procedure that follows it – will be pain-free.

During the appointment, the effect time gives you the opportunity to practice general anxiety and behavioural management techniques with your patient (e.g. breathing exercises). And when you deliver a better treatment experience (for you as well as the patient!), you can create positive expectations for future visits and reduce those costly, frustrating no-shows.

This is especially critical during the COVID-19 pandemic.

When people are already reluctant to seek dental care due to financial concerns or health vulnerabilities, the prospect of a painful treatment can be the final straw. While universal topical anaesthetics will no doubt require a little extra time and expense, we believe they’re a powerful tool that no dentist can afford to be without, during the pandemic and beyond.

What about your non-anxious patients?

So, there’s a clear-cut case for using topical anaesthetics on your anxious patients, but what about the rest of your patient population? Well, your patient may not be anxious at present, but research tells us that there’s a strong correlation between dental anxiety and a previous painful experience. In the Dental Law survey, 46% of people claimed to have had a bad experience,

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INFECTION CONTROL SOLUTIONS

INTRODUCTION 2022 INFECTION CONTROL STRATEGIES FOR YOUR PRACTICE

Welcome to another Dental Solutions and thank you for joining us in the Infection Control Section. Have you had a chance to check out all the resources we have available in the Infection Control Section of Dental Education Hub? If not, be sure to scan the QR code below – we have some quick, free webinars that are great for the whole team! In addition, last year we brought to you several Infection Control Webinars through IC Confidential, this content was developed to plug some of the gaps in the confusion between Guidelines and the changing environment of COVID-19.

For those of you that may have missed out on the IC Confidential 2021 Series, please feel free to register anytime for the On-Demand Webinars. These webinars are roughly between 15 and 30 minutes long, making it easy to fit in some education at lunchtime.

In other news for those of you that read the draft AS 5369:2021, Reprocessing of reusable medical devices and other devices in health and non-health related facilities you would have seen there are some crucial changes that could come with the release so watch this space and stay tuned for more content around this as the year progresses.

For now, thank you again for visiting the Infection Control Section.

Scan here to view the Infection Control Section in Dental Education Hub

Since ADX we have been sending reminders to practices checking your waterlines post the Easter break! Whilst some practices only close for the public holidays, it is still important to check that your dental unit waterline colony forming units is within the accepted as per Australian drinking water guidelines (below <200 CFUml). In this addition we have great content from Dentisan which relates to this.

EMMA JONES CICP-P QLD State Manager Infection Control Specialist

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KIRA FIELD Brand and Marketing Coordinator

RASHI JAIN Infection Control Category Manager

INFECTION CONTROL SOLUTIONS

WHY QUALITY GLOVES MATTER IN DENTISTRY

For dental clinicians, disposable gloves provide an essential first layer of protection to separate their skin from contact with patient fluids (including saliva and blood) and from the over 700 species of bacteria normally present in the mouth. This has direct benefits including the elimination of nail bed infections caused by bacteria, viruses and fungi (i.e. whitlow), which were a major occupational risk for dentists prior to the routine wearing of gloves for all procedures. Gloves protect the skin of the dentist and also reduce exposure to the many hazardous substances used in everyday clinical dental practice, including strong acids, strong alkalis, organic monomers of various types, and solvents such as acetone and ethanol which are found in the bonding agents used in adhesive dental procedures.

A higher quality glove will be more durable and will develop fewer defects over the time it is worn.

Quality gloves will have low levels of polymerizing agents and do not have residual chemicals which are released onto the skin of the wearer and into the mouth of the patient to cause irritation or have a bitter taste for the patient.

Irritant and hypersensitivity reactions to glove chemical accelerants and powders also affect dental clinicians similarly to other clinicians.

The physical characteristics of disposable gloves have a major influence on the safety and performance of the wearer, thus there is no room for compromise.

Contact your local Henry Schein or Ansell representative to find the best glove for you.

Using gloves of a high quality contributes to the long-term health of the hands by limiting contact with other chemicals used in dentistry which can cause irritation or allergy, such as methacrylate resins and aldehydes.

This is an excerpt written by Professor Laurence Walsh for AnsellCARES InTouch Clinical Newsletter - Issue 4. To read the full article and more on quality gloves, visit: https://www.ansell.com/au/en/medical/ services/ansellcares/intouch-quarterly-newsletter.

Historically the rate of defective new examination gloves has been between 1-2% and among surgical gloves it was 1.8%.1,2 Defects in new gloves potentially expose the skin of the healthcare worker to patient fluids, environmental contaminants and microorganisms from the patient.

Scan here to view the Ansell range on our website

Defects can develop as the glove material is stretched during use, for example in the thumb and forefinger regions from grasping items with force, and in fingertip regions from exposure to sharp items. Many dental procedures involve the use of sharp instruments and sharp items, so the glove material must resist tears and punctures. Glove materials vary in their physical properties such as their tear strength. Nitrile gloves are less likely to develop small tears and leaks during use compared to latex gloves, despite not being thicker due to advanced glove manufacturing technologies.

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References 1. Lange, P., Walsh, L. J., & Savage, N. W. (1993). Australian Dental Research Fund Trebitsch Scholarship. An assessment of the permeability of dental protective gloves. Aust Dent J, 38(4), 309-315. 2. Otis, L. L., & Cottone, J. A. (1989). Prevalence of perforations in disposable latex gloves during routine dental treatment. J Am Dent Assoc, 118(3), 321-324.

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INFECTION CONTROL SOLUTIONS

BATCH CONTROL IDENTIFICATION

Batch control identification is a mandatory requirement when sterilising critical items that are used between patients. This is a legal requirement in the event a patient makes claims about inadequate instrument reprocessing in the practice. Together with batch control of instruments we must also keep our steriliser cycle record book. This is best kept in hard copy.

There are various ways instrument packs can be labelled for tracking – through handwriting information on the packs (with correct pens), using a manual labelling gun with adhesive labels or with labels printed by an electronic barcoding system.

We must record key information like the steriliser number, the cycle number, the date of processing and the initials of the person responsible.

Some facilities may have electronic systems in place however, many facilities still use manual procedures where hard copy patient record charts are updated and filed or scanned electronically into the system.

Computer printed documentation labels with barcode only link the contents of a load with a sterilisation cycle. We have to go back to other means of cycle verification to prove that a pack went through a steam sterilisation process.

While electronic cycle reports or physical chart print outs verify that cycle parameters were achieved, it is also mandatory to use a Type 1 chemical indicator on all packs as visual proof each pack was exposed to a steam sterilisation process.

This is why steri-peel packs have a Type 1 indicator on them. But we know once that pack is opened and the instruments retrieved, that pack is going in the bin.

importance when using critical instruments between patients and it is a mandatory requirement to have a system in place to track these items.

Whether you are using an electronic system or a manual documentation system – using the GKE Documentation Labels with Type 1 indicator offers you the following key benefits: 1. Instant clear visual verification of a process having taken place. A pack should go through various checks for having been processed, including a final check at chairside before the pack is opened.

The GKE labels give clear assurance at chairside.

2. Ability to remove the processed label from the pack and adhere to the patient’s chart.

Whether record keeping is physical or electronic, the patient’s notes with GKE indicator adhered, can be maintained as proof that a pack went through a steam sterilisation process.

3. The GKE indicators can be maintained for years, and the chemical indicator colour is guaranteed to not revert or change in any way.

4. Four label colours to choose from (green, blue, red and yellow) all with clear precise colour change of chemical indicator from blue to black. You might choose to use a different colour to denote a different steriliser, a different member of staff or to categorise your instrument packs.

The GKE Manual Documentation System The GKE System comprises the labelling gun, rolls of labels and logbook.

So how do we verify later that instruments that were used on a patient have indeed been through a steam sterilisation process? This is of particular Unprocessed indicator

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Processed indicator

INFECTION CONTROL SOLUTIONS

And is guaranteed to last in excess of 10,000 cycles when handled in accordance with the DFU’s.

This device means less plastic waste – so its environmentally friendly!

The GKE PCD indicator can be adhered to cycle records maintained in the hardcopy steriliser cycle record book.

2. Other Package Monitoring Indicators, eg GKE Type 6

Other considerations for your Batch Monitoring Protocols While we have our Type 1 indicators indicating a package has been through a process, we know that the indicator gives no information about sterility. All it tells us is that the package has been exposed to steam.

This is where we should consider the use of additional chemical indicators.

1. A Process Challenge Device (PCD), eg GKE Orange PCD A PCD should be considered for routine monitoring of all loads, or at least loads with critical instruments or implants at a minimum. PCD’s give us information that no other chemical indicator can. They simulate our instruments with hollow cavities (like handpieces) and tell us about whether air removal and steam penetration have taken place. This principle is very simple for porous items (cotton, gauze) or solid items (like mirrors, explorers or forceps), but is more challenging for more complex instruments with hollow cavities (like hand pieces and burs).

Use of a PCD assures us that air removal and steam penetration occurred for both external and internal surfaces of all instruments.

The GKE Orange PCD has the dual benefit of being able to be used for your Daily Air Removal and Steam Penetration Test as well as for routine monitoring of all loads.

While not mandatory for use if you have a cycle report/chart print out, consideration should be given to the use of these indicators inside instrument packs. These indicators give information about their point of placement and indicate that sterilisation conditions have been met in that position. (Note: they can’t give information about the insides of hollow instruments like a PCD can).

A Type 6 indicator is often recommended as it reacts to all critical variables, i.e. temperature, time and steam.

The benefit of the GKE Before After indicators is the selfsterilisation sterilisation adhesive backing that can be adhered to your patient’s notes (together with the Type 1 indicator) or other applicable documentation kept by the practice.

It’s about Best Practice Aside from the mandatory requirements, each practice must consider their own risk protocols and what additional processes and procedures are appropriate for them, while also considering what is best practice. Because best practice means we are doing what’s best for the patient.

View these products on our website

LAUREN KONTUS BSc(EnvSC) Sales and Contracts Manager GKE Australia

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INFECTION CONTROL SOLUTIONS

OPTIM BLUE EFFECTIVE AGAINST SARS-COV-2

SciCan is pleased to announce that OPTIM Blue Cleaner-Disinfectant was tested and the results confirm efficacy against SARS-CoV-2, the virus that causes COVID-19.

OPTIM Blue is now listed on the Therapeutic Goods Administration List of Disinfectants for use against COVID-19 in the Australian Register of Therapeutic Goods under ARTG Entry 232868.

TGA has approved the claim that OPTIM Blue is effective against COVID-19 within a short 3-minute contact time, on top of being tuberculocidal, viricidal, bactericidal and fungicidal. When applied, surfaces need to remain wet for only 3 minutes to inactivate pathogens.

The perfect balance between safety and efficacy.

OPTIM Blue is safe and gentle for you and your surfaces while being one of the fastest and most effective CleanerDisinfectants on the market today. OPTIM Blue Cleaner-Disinfectant Wipes and Liquid are powered by a unique non-toxic formula that is non-irritating and non-respiratory sensitizing. OPTIM Blue products are not classified under any GHS hazard class – there are no physical or health hazards associated with OPTIM. Users can have the confidence that they won’t be harmed when using OPTIM according to the label directions.

Oral healthcare workers should continue to diligently follow infection control protocols.

For health care workers, the outbreak has heightened awareness around the dangers and

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spread of viruses and reinforced the importance of properly completing and monitoring infection control protocols.

Between patient visits, clean and disinfect all clinical contact surfaces, such as the dental chair. Also make sure to regularly clean and disinfect surfaces that present the highest risk of infection in your SteriCentre (e.g. surfaces that come into contact with contaminated instruments and gloves).

Before you clean or disinfect contaminated surfaces, wear the proper Personal Protective Equipment, as per local infection control guidelines.

As stated in OPTIM Blue disinfectants’ Safety Data Sheets, PPE is not required to handle the product because it is not irritating to the skin under normal use conditions. However, PPE such as utility gloves must be worn to protect oral health care workers from infectious materials present on soiled surfaces.

Scan here to view the Optim Range on our website

INFECTION CONTROL SOLUTIONS

ARE YOUR CHAIRS SAFE TO OPERATE?

For most of us we have enjoyed some public holidays over the Easter period, I’m sure you didn’t stop to think what your dental unit waterlines were doing during this time? Whilst the chairs have been and closed down, without the day to day flushing and without the cool of the air-conditioning, the chances are your chairs have grown some biofilm during this time.

air/water syringes and mouth rinsing water, exposing patients and staff to microorganisms in fragments of biofilm that can cause illness.

Biofilm occurs in dental unit waterlines because of the long, small-diameter tubing and low flow rates used in dentistry, the frequent periods of stagnation, and the potential for retraction of oral fluids. As a result, high numbers of common water bacteria can be found in untreated dental unit water systems.

A few disease-causing microorganisms found in untreated dental unit water include Legionella, Pseudomonas aeruginosa, and nontuberculous Mycobacterium. Dental health care personnel and patients could be placed at risk of adverse health effects if water is not appropriately treated (1).

Maintaining water quality is of considerable importance, primarily because both patients and the dental team are regularly exposed to water and aerosols generated by dental equipment. If biofilms can form in DUWLs, the pathogens settling on the internal wall of the tubing can then enter the oral cavity via high-speed handpieces, ultrasonic scalers,

It is good practice to test microbial levels in water from dental unit waterlines on a regular basis, for example, six-monthly or annually, when tested levels are found to be below the target level of 200 CFU/mL. When high counts are found, the waterlines will need to undergo additional sanitising treatments (also called shock treatments) to remove biofilms and bring the bacterial levels back to within an acceptable range.(2) Refer to the new Australian Dental Association Guidelines for Infection Control 4th Edition, page 30

Dentisan Water Maintenance Products available through Henry Schein: Bioclear Daily 1 litre bottle QD-DS0241 Dentichlor Tablets Water Bottle Disinfectant QD-DS290 Bioclear Kit 12 Pack x 200ml bottle shock treatment QD-DS025200 Bioclear Dip Slides QD-DS026 Dentisan Test Strips 50 per Bag QD-P1TESTSTRIP

Scan here to view and order these products on our website.

Scan here to view “Water Quality Issues in Dental – Introduction to Water Filtration” Webinar

References www.ada.org.au/Dental-Professionals/Publications/Infection-Control/ Guidelines-for-Infection-Control/Guidelines-for-Infection-Control-V4.aspx} www.cdc.gov/oralhealth/infectioncontrol/faqs/dental-unit-water-quality. html#:~:text=Biofilm%20occurs%20in%20dental%20unit,untreated%20 dental%20unit%20water%20systems. Accessed 8 March 2022

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DENTAPURE™ CARTRIDGE DENTAL ADVISORS TOP PRODUCT NINE YEARS IN A ROW

One cartridge gives one year of treated water DentaPure™ Cartridges are easy-to-use and require low maintenance while providing compliant1 treatment water for 365 days or 240L.

Stages of microbial growth in untreated waterlines

The narrow width, extensive length, and dark/moist environment of dental unit waterlines (DUWLs) provides the ideal home for the growth and survival of colonies of microorganisms.

When untreated or improperly maintained, the water flowing through these contaminated DUWLs and out through the air/water syringe or high-speed handpieces can carry pieces of biofilm that have broken off of the waterline wall – potentially harming patients, staff, and a practice’s reputation. Minimize the potential for microbial growth in your DUWLs with one yearly installation of the DentaPure™ Cartridge.

Watch Educational Webinar – Total Water Management & Compliance in the Practice

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INFECTION CONTROL SOLUTIONS

Compliant1 •

Simple

DentaPure™ DP365B and DP365M Cartridges continuously provide one-year or 240L of compliant1 procedural water that exceeds the current EPA standard (<500 CFU/mL) for potable water.

•

DentaPure™ DP40B Cartridges continuously provide 60 days 40L of compliant1 procedural water.

•

EPA registered to provide ≤200 CFU/mL for oneyear or 240L of water2.

• •

FDA 510k2.

Use is not restricted by the EPA Rule BMP for dental amalgam waste3.

Effective •

•

Reduces patient and staff bacterial exposure by eluting elemental Iodine into water used during patient treatment.

Elemental iodine (I2) is non-allergenic – no protein is attached to it4.

•

For use in independent water bottles and dental units municipally plumbed to city water.

• • •

For use with all potable water.

• •

No routine shocking.

•

Dispose of depleted cartridges in the regular office trash

•

Cost-effective.

Minimal maintenance required following installation.

Fewer protocols reduce the possibility of human error.

Bottle-style cartridges can be quickly and easily installed by office staff.

Reliable • • • •

Will not interfere with dental materials and bonding5.

•

Dedicated DUWL technical support.

No concerns with corrosion or etching6.

No harsh chemicals.

Replacement reminder program in place.

How it works

The DentaPure™ Cartridge contains non-allergenic iodinated resin beads

As water passes through, the resin releases 2-6 ppm of atomic isotopes of elemental iodine (I2) during a typical dental treatment

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The (I2) isotopes control the bacteria, keeping procedural water compliant1 for 365 days (240L)

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INFECTION CONTROL SOLUTIONS

STERILE GOWNS A SUITABLE LAYER OF PROTECTIVE CLOTHING

The Therapeutic Goods of Australia (TGA) lists on their webpage, Guidance on Personal Protective Equipment for Health Professionals, that a sterile gown is a ‘fluid-resistant, disposable garment made of natural and/or synthetic materials worn over a scrub suit to cover the arms, trunk, and upper legs, during a surgical procedure, to help protect both the patient and operating room personnel from the transfer of microorganisms, body fluids, and particulate material’(1).

Gowns are designed to provide complete protection against contact with blood, body fluids and other potentially infectious materials. To ensure these gowns fit correctly and protect against exposure to body fluids and infectious materials at the critical zones on the gown, they should cover from the neck to the knees and sleeves should finish at the wrists with cuffs. They should have enough overlap at the back that they do not separate when the person wearing them is sitting and come to below the knee(2).

According to the Guidelines for Infection Prevention and Control Fourth Edition released October 2021, “Disposable sterile surgical gowns are suitable for use for oral surgery as a single-patient-use item.

These gowns typically have long sleeves that extend to the area of the wrist that will be covered by the cuff of sterile gloves. At the end of the procedure, they should be placed into the general waste, or if visibly contaminated with blood, disposed of according to local waste management regulations.(3)”

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It is also imperative to take note that the Guidelines also state that: When scrubs are worn as the everyday practice uniform throughout the clinic, it is necessary to wear a suitable layer of protective clothing on top of these. This would normally be a suitable disposable or reusable gown (e.g. short-sleeved for routine dentistry, or long-sleeved and sterile for surgical dental procedures).

Henry Schein has released a new sterile gown that comes in single packs. These sterile, single-use gowns are AAMI Level 2 Rating, non-woven and made of hydrophobic material. They have 4 ties and a tie-round which enables sterility of the users back. It is important to note that these gowns also have knitted elastic cuffs for greater comfort and come in sizes medium, large and extra-large.

References Australian Government Department of Health, Therapeutic Goods Administration, 9 December 2021, Guidance on Personal Protective Equipment for Health Professionals, accessed 10 March 2022, {https://www. tga.gov.au/guidance-personal-protectiveequipment-health-professionals} Australian Dental Association, 2021, Guidelines for Infection Prevention and Control Fourth Edition, accessed 10 March 2022, { https://www. ada.org.au/Dental-Professionals/Publications/Infection-Control/ Guidelines-for-Infection-Control/Guidelines

View and purchase these gowns today on our website.

DENTAL SOLUTIONS

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

VOLUME 4

FEB / MARCH 2022

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INFECTION CONTROL SOLUTIONS

CYCLE RECORD COMPLIANCE WITHOUT THE NEED OF A PRINTER

The Mocom range of sterilisers meets the intended requirements of Australian Standard/s without the need for a printer.

Mocom are internationally recognised as experts in the design and manufacture of sterilisers and hold compliance certificates for all relevant international standards. The Supreme, Futura and Classic series have been specifically designed by Mocom to meet onscreen parametric release requirements.

AS4815 is the applicable Australian standard currently for General Practice (“office-based practice”).

A summary of the sections that refer to Parametric Release (i.e. the “authorised person” checking that all the required parameters have been met before “releasing” the load for use) are as follows: Table 7.1 - Cycle monitoring (every load) – this says you must have: • Print-out of cycle parameters or • Direct observation and recording of cycle parameters (i.e. writing them down every 10 seconds!) or • Class 4, 5 or 6 chemical indicator (where no print-out is available).

And… • Class 1 chemical indicator in each load of unwrapped items.

• Class 1 external chemical indicator on the outside of every packaged item in the load.

And optionally: • Biological/enzymatic indicator(s).

• Chemical indicator-on tray or inside pack(s) (Class 1, 4, 5 or 6).

• Process challenge device(s) reflective of the type of loads processed.

Clause 7.7.4.1 says in relation to the physical parameters to be monitored: • They shall include time and temperature, and, where applicable, pressure.

• The parameters shall be automatically measured and permanently recorded (by print-out or non-volatile electronic record).

• The monitoring must identify that critical physical parameters have been met (cycle type / time / temp / pressure) • At the end of each cycle, the operator shall …verify that correct cycle parameters were met and record it to permit later identification (of the operator).

• For existing steam sterilizers (with no printer), …a Class 4, 5 or 6 chemical indicator shall be used with each load.

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INFECTION CONTROL SOLUTIONS

So, the “parameters” that the authorised operator must verify prior to “release” of the load are: 1.

2.

3.

4.

5.

6.

The correct (intended) cycle was run (identifying the cycle name and number) The target sterilising time was achieved The target sterilising temp was reached and was within limits The target sterilising pressure was reached and within limits The cycle was completed fully and had a “positive” result The operator who released the load can be identified AND 7. The packs are dry 8. The packs are intact 9. The correct cycle was run for the pack/s being processed

The Mocom range presents all of the required physical parameters on the screen at the end of each cycle, then requires the operator to identify themselves, before the steriliser opens the door. This cycle and operator detail are recorded within the steriliser for later download.

Below is a typical Mocom Futura “Completed” cycle screen and the Operator Screens that follow, showing that points 1 – 6 listed above confirm that this data is presented to the operator at completion of a cycle, therefore no printer is required.

This “onscreen parametric release” functionality in the Mocom range of sterilisers meets all the requirements for authorised parametric release without the need for a printer. The operator must select their name and enter their (unique) pin number in order to open the door of the steriliser, adding an extra layer of security and preventing unauthorised (or accidental) release of a load.

You may have experienced other steriliser brands that show a “completed” screen without detail at the end of the cycle, but the Mocom “completed” screen includes all parametric release data and still will not open the steriliser door without recording the authorised operator. In our view this more than meets the requirements and intent of the standard.

In our view, Onscreen Parametric Release is only acceptable if the authorised operator can identify all parameters and the operator can be identified and securely recorded permanently. We strongly agree with the view that “Completed” is not enough (unless a Class 4,5,6 Indicator is used and recorded).

JIM OWEN Sales Relationship Manager Mocom Australia h en r y sc h e i n .c o m .a u

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HENRY SCHEIN ONE

MORE TIME TO DO DENTISTRY

The events of the last two years have changed how dental practices operate. Now, more than ever, implementing time-saving practice management is imperative to the successful and seamless running of your business.

We understand dental practitioners have had to adapt multiple times and have faced challenges when delivering much-needed patient care and safeguarding staff over the last 24 months. Our top priority now, as it always has been, is saving you time whilst ensuring you can deliver the highest standards of dentistry to those in need.

As normality slowly returns, naturally, you may be feeling apprehensive towards your seemingly neverending to-do list. Introducing a practice management software that saves time is guaranteed to make the transition to regularity a seamless experience for you and your practice staff.

Dentally provides you with the perfect tool kit to stay on top of admin and keep control of your hectic diary. Our cloud-enabled software offers flexibility from task automation, easy to use calendars,health funds integration, simple to use clinical charting and real-time reporting - you and your staff can expect a simple, efficient and agile return to normality.

Cloud-enabled solution Your practice can use Dentally as a tool to save you time - because you have more tasks to complete now than ever before.

Dentally offers a practice management software that not only saves time but reduces the burden of mundane admin tasks - allowing for your staff to be more efficient when managing patient care.

Whether we look at task automation and easy charting to clinical efficiency and automated communications - your team can rest assured that monotonous admin tasks are no longer a timeconsuming part of their hectic day.

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Secure remote access Many staff members have been working from home over the last two years for many reasons, from shielding to child care. Our secure cloud-based software enables you to rest easy knowing that staff can access all aspects of Dentally, whether they’re on-site or at home. This level of flexibility means no disruption when it comes to providing vital patient care.

Resources such as shared calendars, diary access, Dentally Chat, and Task Lists ensure that your remote staff never miss anything. Whether that be practice updates, patient notes, or a simple Dentally Chat message requesting more tea bags for the practice - no matter the issue, staff will feel included and notified regardless of their location.

Automation Automating your patient communications can make a patient journey seamless and safe - thus saving you and your staff valuable time. Automation allows you to set up and schedule messages triggered by events within the patient’s journey.

Appointment bookings, invoices, or pre and post appointment documents that require signatures your patients and practice know that it will all be handled effortlessly, with no chance of any step getting missed.

Dentally can help you save time completing day to day tasks, ensuring that you have more time to do the important stuff - dentistry. Visit our website now to find out more at www.dentally.com.au.

Find out more about Dentally

HANDPIECE SOLUTIONS

THE BENEFITS OF AUTOMATED HANDPIECE LUBRICATION FOR OPTIMAL PERFORMANCE OF HANDPIECES

Dental handpieces are a costly investment and every dental practice could benefit from having a simplified protocol to ensure the proper care and maintenance of their handpiece inventory.

Poorly maintained dental handpieces can compromise the quality of performance, lead to potential health and safety risks and can cause costly and time-consuming repairs.

It is important to follow the maintenance recommendations of the handpiece manufacturer but almost universally they recommend handpieces are lubricated, purged and chuck maintenance performed on both highspeed and speed increasing red band contra angle handpieces.

M-LUBRINA2

• •

Automating handpiece maintenance provides precise and consistent lubrication and purging of handpieces which ensures optimal performance and longevity, increases efficiency as multiple handpieces can be lubricated in one cycle and can significantly reduce the amount of lubricant required.

• • • • • •

Morita’s Lubrina 2, with programmable maintenance modes, can effectively and efficiently perform purging and lubrication of 4 handpieces (highspeed or contra angle), automatically. The new Clean AirBlow function with double-conduit design, ensures residual water is removed from the handpiece prior to oiling, maximising lubrication results. The Clean Air-Blow also effectively removes any surplus oil prior to bagging and autoclaving your handpiece.

• •

NEW Clean Air-Blow System Dedicated built-in, one touch, Chuck Maintenance port NEW Oil mist suction removal 20 second high speed handpiece maintenance Programmable maintenance modes for different handpiece types Maintains up to 4 handpieces in one cycle Multiple handpiece coupling options available Compatible for use with other manufacturer’s lubricant Quiet operation Simple unit maintenance

The Lubrina 2 is the cornerstone of a standardised, efficient and effective handpiece maintenance protocol for dental practices, minimising maintenance costs and maximising handpiece longevity.

Watch the video here

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INSTRUMENT SOLUTIONS

SIGNATURE SERIES PROCEDURE TUBS GET ORGANISED & BE EFFICIENT

imS caSSeTTe and Tub SySTem

IMS and Tub System How caSSeTTeS and TubS work TogeTHer:

A different tub and color can be used for each different procedure type (crown & bridge, composite, etc.).

How Cassettes and tubs work together:

• Together, procedure tubs and cassettes create the most efficient andprocedure organized system for cassettes managing instruments • and Together, tubs and create consumable products.

the most efficient and organized system

• Time savings achieved by using IMS (Instrument for managing instruments and Management System) cassettes andconsumable procedure tubs will allow the staff to spend time on more value added products. activities in the dental office.

••

•

Procedure tubs can be usedby asusing portable operatory Time savings achieved IMS (Instrument drawers to store, organize and transport consumable Management cassettes and procedure materials to and System) from the storage/sterilization area and the operatory. tubs will allow the staff to spend time on more

• All of the materials needed specificoffice. procedure can value added activities infor thea dental be stored in the tub. A different tub and color can be for eachtubs different type (crown & bridge, • used Procedure can procedure be used as portable composite, etc.).

An example of how it works:

•

operatory drawers to store, organize and

• The Signature Series procedure tubs are available in transport consumable materials to andallow fromthethe colors that match IMS cassette rails, which staff tostorage/sterilization match the tubs and cassettes procedure. area andbythe operatory.

•

The Signature Series procedure tubs are available in colors that match IMS cassette rails, which allow the staff to match the tubs and cassettes by procedure.

All of the materials needed for a specific procedure can be stored in the tub.

an examPle of How iT workS:

Blue cassette rails and a blue tub may represent

• Blue cassette rails and a blue tub may represent a procedure.

All of materials for a composite composite procedure.

Allthe of consumable the consumable composite procedures can be stored and organized in the materials for composite procedures can be blue tub and instrumentation stored in the cassette with blue rails, for quick stored andallowing organized in theidentification. blue tub and

instrumentation stored in the cassette with blue rails, allowing for quick identification.

Procedure Tub SeT-uP examPleS Signature Series Procedure Tub Benefits:

Hygiene

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Sealants

Composite

Endontics

Crown and Bridge

CASSETTE RAIl COlORS

• • •

Increases office organization and workflow efficiency Allows for quick identification of consumable products Provides esthetic integration with IMS cassettes

AllOwS FOR STORAGE OR EACh OPERATORy

•

Tubs can be transported procedure, eliminating in in each operatory

INSTRUMENT SOLUTIONS

microban® a

SignaTure SerieS™ TubS

Standardises material set-up for every type of procedure

•

Increases efficiency of materials management

•

Eliminates time-consuming tray preparation for every procedure

•

Tubs may be configured to meet your office needs or are available as a complete tub

SignaTure Series™ Tub

Microban protection manufacturing proc functions that allow Microban protection contact with the pro microbes that can c of the product.

Includes: • Signature Series Tub • Tub Liner*

• Tub Divider (package • Single Tub Cup w/Cov • Double Tub Cup w/Co • Divided Slide Tray • Locking Tub Cover*

Procedure tub colours match Hu-Friedy IMS Cassette Rail Colours

•

Increases office organization and workflow efficiency

•

Allows for quick identification of consumable products

•

Provides esthetic integration with IMS cassettes

Locking Covers

•

Protects items from airborne materials during transportation and storage

•

Adheres to infection control standards

Microban® Antimicrobial Product Protection Microban protection is integrated into the tub and tub components during the manufacturing process.

Microban technology works by interrupting key cell functions that allow the microorganisms to function, grow and reproduce.

Microban protection begins to work as soon as the microorganism comes into contact with the product surface and works continuously to inhibit the growth of microbes that can cause stain, odors and product degradation – for the lifetime of the product.

Microban® Antimicrobial Product Protection

•

Microban inhibits the growth of microorganisms that can cause stains, odors and product degradation

•

Microban is registered with the EPA for these applications

Allows for storage in central sterilization or each operatory

•

Tubs can be transported to the operatory prior to each procedure, eliminating inventory management of materials in each operatory

Includes: Signature Series Tub, Tub Liner*, Tub Divider (package of 8), Single Tub Cup w/Cover*, Double Tub Cup w/Cover*, Divided Slide Tray, Locking Tub Cover* *Clear components and Tub Liner do not contain

Signature Series Tubs are designed to match IMS cassette rail colors and feature antimicrobial product protection. Together, procedure tubs and cassettes create the most efficient and organised system for managing instruments and consumable products. The time savings achieved by using IMS (Instrument Management System) cassettes and procedure tubs allow staff to spend time on more value-added activities in the dental practice.

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INSTRUMENT SOLUTIONS

ELEVATE YOUR PRACTICE WITH PRECISION INSTRUMENTS

Designed to provide total solutions for your Atraumatic Extractions Luxating Hybrids

Interchangeable Periotomes Hu-Friedy’s Interchangeable Periotome features four thin, sharp interchangeable blades for severing the periodontal ligament. The blades are securely positioned in the handle and removable for easy cleaning, care and replacement.

• Straight spade Luxating Hybrid severing the periodontal ligament.

Luxating Hybrids are designed with thin, precisely angled tips to aid clinicians in preserving the buccal plate during atraumatic extractions.

• • • •

Improved apical and interproximal access with thin working tips Easily severs the periodontal ligament with finely honed, sharp cutting edges Enhanced oral adaptation with 7 precisely manufactured tip options Longevity and corrosion resistance afforded by handcrafting from the finest grade surgical stainless steel

Small Distal HF-EPTSMD

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Straight Spade HF-EPTSSP

• •

Thin, sharp blades available in four designs to easily sever the periodontal ligament Large diameter handle for enhanced ergonomics, tactile feel and optimal clinical performance Longevity and corrosion resistance afforded by hand- crafting from the finest grade surgical stainless steel

Interchangeable Periotome Tip, Angulated - HF-PT19

INSTRUMENT SOLUTIONS

HF-PT6Anterior, Straight, Single Ended

Periotomes

Luxating Elevators

Hu-Friedy periotomes are designed to facilitate the removal of teeth with minimal damage to the surrounding alveolar bone.

Luxating elevators reduce pressure on adjacent teeth as they are used in a rocking motion for cutting as opposed to a standard elevator that lifts and pries.

• • •

Thin, clinically designed blades to sever attachments easily Unique, smooth, large diameter lightweight handle for maximum comfort and increased control* Available in both Single-Ended and DoubleEnded, Posterior and Anterior Applications, Satin Steel® or Black Line designs

• • • •

* Gerwatowski, L.J., McFall, D.B., Stach, D.: Carpal Tunnel Syndrome; Risk Factors and Preventive Strategies for the Dental Hygienist. Journal of Dental Hygiene, February 1992.

Designed with sharp, thin blades for cutting periodontal ligaments Provide better leverage for increased performance during procedures Handcrafted from Immunity Steel® and heat treated to provide optimal sharpness and durability Available in standard, Ergo Dynamic, or Black Line designs

Additional Black Line Design Features:

• • •

Performance engineered coating for a harder, smoother surface providing optimal edge retention Reduced light reflection afforded by a matte finished handle and black working ends Distinct black finish for enriched contrast and visual acuity at the surgical site

Ergo Dynamic™ Elevators One handle size does not fit all individuals. Ergo Dynamic elevators were designed to offer an alternative handle option to better fit within the palm of your hand.

•

Posterior, Double Ended, Black Line HF-PT1X

Additional Black Line Design Features:

• •

•

Performance engineered coating for a harder, smoother surface for optimal edge retention and enhanced lubricity Reduced light reflection afforded by a matte finished handle and black working ends

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Ergo Dynamic Elevators increase comfort and ease of use for clinicians who prefer small handle elevators Provide better leverage for increased performance during procedures Handcrafted from Immunity Steel and heat treated to provide optimal sharpness and durability

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INSTRUMENT SOLUTIONS

Actual Size Comparison Ergo Dynamic Small Elevator, Standard Elevator and Black Line

Straight, 5 mm HF-EL5SSM Ergo Dynamic Handle

Straight, 5 mm HF-EL5S Standard Handle

Straight, 5 mm HF-EL5SX* Black Line Handle

*Black Line handle option only available in Luxating Elevators.

NEW Sllm Elevators designed to be 13-20% Slimmer than standard elevators !

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Slim Elevators are ideal for atraumatic extractions.

The slender working end glides along the alveolar bone and severs the periodontal ligaments during surgical extractions.

Features & Benefits

• • • • • • •

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Available in multiple sizes, lengths, and shapes providing customized treatment based on patient need Lightweight, large diameter handle for maximum comfort, reduced hand fatigue and increased control* Available in Black Line and Standard StainlessSteel Performance engineered coating for a harder, smoother surface for enhanced lubricity and optimal edge retention Distinct black finish for enriched contrast between the instrument, surgical site and underlying tissue Reduced light reflection afforded by a matte finished handle and black working ends

Slim Elevators, Long HF-ELSLIM2CLX

Slim Elevators, Short HF-ELSLIM2CSX

*Source: Gerwatowski, L.J., McFall, D.B., Stach, D.: Carpal Tunnel Syndrome; Risk Factors and Preventive Strategies for the Dental Hygienist. Journal of Dental Hygiene, February 1992.

All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC its affiliates or related companies, unless otherwise noted. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved.

HFL-577/0421

HANDPIECE SOLUTIONS

CARE, MAINTENANCE & STERILISATION OF YOUR HANDPIECES

To get the best out of your KaVo handpieces and to ensure prolonged working life, the below stages are essential.

1.

Remove bur from handpiece

6.

2.

Clean the outside of the handpiece under running water. Do not clean the handpiece in disinfectant or immerse your handpieces in any chemical solution, including water.

Sterilise in autoclave. Remember to change distilled water in the autoclave on a regular basis. (Note: Recommended temperatures must not be exceeded).

7.

Upon completion of cycle, remove handpiece from chamber as soon as possible and store with head upright, until cool and internally dry. Do not leave handpieces in autoclave.

8.

Once dry and cool, handpieces can be stored in a bag, cupboard, drawer or upright on a handpiece stand.

9.

Run handpiece briefly before use to clear excess lubricant. Do not lubricate prior to use.

3.

Separate head and shank as appropriate.

4.

Lubricate the head and handpiece separately with KaVo Spray and the appropriate nozzle. Repeat until clean lubricant appears from the chuck. Always shake the can prior to use and keep upright when lubricating.

5.

Use tissue to clean handpiece of any excess lubricant.

Handpieces must be sterilised by autoclaving after each patient.

Don’t forget to send your handpieces to Handpiece Hotline for service.

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

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INSTRUMENT SOLUTIONS

NEW KAVO SURGMATIC S15 L PRO THE NEW ALL-ROUNDER AMONGST SURGICAL INSTRUMENTS

SURGmatic S15 L Pro: The new all-rounder amongst surgical instruments.

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in surgical dentistry and takes surgical work to a whole

In new addition level. to surgical applications such as the removal of wisdom teeth, hemisections, osteotomies or A real apicectomy, non-surgical activities such as all-rounder preparations, crown lengthening or the separation of Its advanced speed asset makes the KaVo SURGmatic S15 L Pro crowns can also be carried out effortlessly. not only noticeably more efficient, but also a real all-rounder

Too cool to overheat The new KaVo CoolHead technology ensures a cool instrument head

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at all times.

in the surgical Thanks to thepractice. high speed and the compelling cutting performance, inconvenient instrument changing addition to surgical applications as the removal of is is Inno longer necessary and asuch smooth workflow wisdom teeth, hemisections, osteotomies or apicectomy, guaranteed.

The new KaVo CoolHead technology ensures a cool instrument head at all times.

non-surgical activities such as preparations, crown

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INSTRUMENT SOLUTIONS

Working simply becomes easier - you'll have a cool head and a clear view.

Working becomes easier – with a cool head and a clear view.

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This ensures a particularly homogeneous

cooling effect while guaranteeing a Compelling ergonomics, hygiene and quality harmonious spray effect without any

With the compact head size, the low weight and the compelling lighting effects, the SURGmatic S15 L Pro creates spray shadows. the best conditions for ergonomically healthy and permanently relaxed work. The precise KaVo Made in Germany manufacturing quality, with high-quality materials and a hard metal guide bushing ensure more precision thanks to low vibrations and a high level of robustness. Of course, the SURGmatic S15 L Pro can be thermodisinfected and sterilised up to 135 °C.

Saves time for team

Compelling ergonomics, hygiene and quality

The precise KaVo Made in Germany manufacturing quality,

With the compact head size, the low weight and the

with high-quality materials and a hard metal guide bushing

compelling lighting effects, the SURGmatic S15 L Pro

ensure more precision thanks to low vibrations and a high

creates the best conditions for ergonomically healthy

level of robustness. Of course, the SURGmatic S15 L Pro can

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be thermodisinfectedScan and sterilised up the to 135 °C. here to see new

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The high cutting performance saves valuable time and enables short, gentle patient treatment.

Everything under one click: See the new SURGmatic S15 L Pro for yourself online.

1 3 0 0

www.kavo.com/de/s15

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2 2

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INSTRUMENT SOLUTIONS

Z.O.B.E. ZIRC’S ORGANIZATIONAL BOX OF EFFICIENCY

Where did we put it?” If you’ve heard these words in your office—or have uttered them yourself—you know that disorganization can translate into wasted time, missing materials, and increased stress. And if you keep promising to get organized tomorrow, you might be realizing that tomorrow never seems to come.

Dr. Deanna Barden knows that feeling well. “We were stocking each room with everything as opposed to just the essentials,” she said. “It wasn’t functional, and as our office continues to expand and we have new employees, the system we had wasn’t conducive to the team being able to jump in and help,” Dr. Barden added.

Designed to optimize efficiency, Zirc products provide easy, timesaving, affordable organization solutions for materials and instruments for chairside use, sterilization, and storage. Zirc’s Organizational Box of Efficiency (Z.O.B.E.) contains 30 of the company’s topselling products. The kit is shipped to a dental practice, and employees give the products a handson try to see what works for their practice before purchasing any of the products. Z.O.B.E. comes with the help of a Zirc efficiency expert, who devises a tailor-made organizational plan for each practice.

After color-coding her entire office and incorporating Zirc’s tub system, Dr. Barden said their office productivity has increased, reducing stress for new employees and helping with training. She concluded, “Z.O.B.E. made me and our assistants more efficient with our time, which ultimately means I could concentrate on the actual procedure and get it done faster.”

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Range of Products Z.O.B.E. arrives at the office with 30 products— and without a shipping charge. The kit includes storage tubs that serve as portable operatory drawers, B-Lok instrument trays with locking covers, and a variety of instrument holders, including Zirc’s Cassettes, which reduce the time needed to clean and locate instruments, increase instrument longevity, and reduce risk of injury. E-Z ID color-coded rings and tape facilitate tool and material identification and come in an easyto- use pre-assembled dispensing system. The list continues with Bur and Endo Holders, “bonus” isolation and moisture control products, and more.

“After receiving numerous samples, we were able to see how the products would work within our practice,” said Dr. Dana Blalock, who wanted to improve organization between operatories. “It was great to be able to place our materials in their cassettes and bins to determine the best fit for our needs,” she said. Dr. Blalock added, “Their products are solid, well made, and ergonomically efficient.”

Dealing with loss of inventory, disorganization of supplies, and risk of injury during sterilization, Traci Portnoff, DMD, found that Z.O.B.E offered many organizational systems of tubs, trays, and cassettes with lots of small compartments for organizing.

Dr. Barden said she liked “the color-coding and bright fun colors,” explaining, “it just takes all the guesswork out.”

Zirc’s Organizational Box of Efficiency • The ZOBE demo kit ships to your practice at NO cost – Free ZOBE, free shipping, free return

INSTRUMENT SOLUTIONS

• Consult and share your needs with your Zirc efficiency expert, who will review the amount of patient flow for each procedure • ZOBE contains over 30 of our top-selling products for organization • Receive a custom plan that’s right for you and your practice • Ship ZOBE back with prepaid return label

eaways

• Includes 30 of

• Provides affordable,

• E-Z ID colorcoded rings and tape facilitate tool and material identification.

• Only available in USA;Zirc’s Contact Zirc for more information top-selling time-saving organization organization products in a single kit.

solutions for materials and instruments for chairside use, sterilization and storage.

ORDER TODAY!

Visit us at www.zirc.com/zobe or call 800.328.3899 mulate a custom plan tailored to the needs

Bilyana ic, DDS; erey, CA

• A Zirc ‘efficiency expert’ helps formulate a plan customized to the needs of each practice.

Overall Satisfaction

“THE CONSULTANT of each practice. “The consultant definitely All of the evaluators said they would rechelps tailor products to each practitioner’s ommend Z.O.B.E. to their colleagues, with DEFINITELY HELPS needs,” said Dr. Tesic.

Dr. Blalock shared, Dr. Barden commenting that the products TAILOR PRODUCTS “Their sales representative is very helpful are well made and save time. She added, TO EACH and knowledgeable with suggestions for “I would recommend [Z.O.B.E.] to anyone PRACTITIONER’S organizing,” and Dr. Bardent called Zirc’s trying to get more organized, reduce clutter NEEDS.Improved Organization and Efficiency custom plan tailored to the needs of service “fantastic and slick.” Zirc will soonformulate andareduce duplication of materials.”

offer a full-service with Z.O.B.E. each practice. “The consultant definitely helps tailor Hoping to change the disorganized flowoption of products to each practitioner’s needs,” said Dr. a dental practiceTesic can opt to have an gonomically efficient.”

FOR FREE INFORMATION: instruments and dentalwhere materials, Dr. Bilyana Tesic. Dr. Blalock shared, “Their sales representative commented, “The whole [Z.O.B.E.] system is into the practice to efficiency expert come ing with loss of inventory, disorgani800.921.4806 ext. 136 is very helpful and knowledgeable with suggestions very with color-coded help implement the system and train thefor organizing,”www.dps.li/a/5Q9-204 of supplies, and risk of streamlined injury during and efficient, and Dr. Bardent called Zirc’s service instruments/trays/bins for different dental team. procedures.” She ation, Traci Portnoff, DMD, found that CircleZirc 204will on soon the card “fantastic and slick.” offer a full-service estimated that the time saved from not having to set E offered many organizational systems option with Z.O.B.E. where a dental practice can opt up or break down operatories was about 10 minutes to have an efficiency expert come into the practice , trays, and cassettes of “It made life easier for both dentist per with case,lots adding to help implement the system and train the dental PRODUCT EVALUATION SNAPSHOT ompartments for and organizing.

Dr. assistant. Even the new intern knew exactly team.

CRITERIA BASED ON AVERAGE SCORE (OUT OF 5) n said she liked “the color-coding and that his staff is now more what to do.” Noting efficient andtakes organized, Dr. Jesse Ritter said, “The Overall Satisfaction fun colors,” explaining, “it just 1 2 3 4 5 and tray set ups guesswork out.” colors made identification easy, Range / variety of products All of the evaluators said they would recommend with lids help expedite set up for procedures.” available in Z.O.B.E. kit Z.O.B.E. to their colleagues, with Dr. Barden ved Organization and Efficiency Company Assistance commenting that the products are well made Convenience of being able to see/ and save time. She added, “I would recommend ing to change theOnce disorganized flow a dental practice receives new Z.O.B.E. feelthe products before purchasing [Z.O.B.E.] to anyone trying to get more organized, uments and dental Dr. Bily- expert will consult with key kit,materials, a Zirc efficiency reduce clutter and reduce duplication of materials.” sic commented, “The whole [Z.O.B.E.] Knowledge employees on a phone call and listen to their needs.of Zirc efficiency They discuss patient flow for each procedure and expert m is very streamlined and efficient,

olor-coded instruments/trays/bins Convenience of color-code erent procedures.” She estimated system e time saved from not having to set PRODUCT EVALUATION SNAPSHOT Improved understanding of break down operatories was about CRITERIA BASED ON AVERAGE SCORE (OUT OF 5) material management and utes per case, adding “It made life instrument management 1 2 3 4 for both dentist and assistant. Even Range / variety of products availableoffice in Z.O.B.E. kit Improved organization 4.6 w intern knew exactly what to do.” (after purchasing products) ng that his staff is now more efficient Convenience of being able to see/ feel products before purchasing 4.8 Improved efficiency of ganized, Dr. Jesse Ritter said, “The procedures (after 4.5 Knowledge of Zirc efficiency expert made identification easy, and tray purchasing products) s with lids help expedite set up for Convenience of color-code system SECTION A 4.8 dures.”

Improved understanding ofAVERAGE

pany Assistance

material management and instrument management

SECTION Improved office organization (after purchasing products)

5

FINAL SCORE AVERAGE OF SECTIONS A&B

4.6

4.6

B 4.6

OVERALL SATISFACTION e a dental practice receives the new Improved efficiency of procedures (after purchasing products) 4.6 E. kit, a Zirc efficiency expert will ZIRC COMPANY t with key employees on a phone FINAL SCORE SECTION A AVERAGE 4.6 ZIRC’S ORGANIZATIONAL AVERAGE OF d listen to their needs. They discuss SECTIONS A AND B BOX OF SATISFACTION EFFICIENCY (Z.O.B.E.) SECTION B OVERALL 4.5 t flow for each procedure and for-

NO. 8

4.6

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

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EQUIPMENT SOLUTIONS

CLINICS CANNOT SURVIVE UNLESS THEY REINVENT THEMSELVES

Dr Didier Stephanus has a clinic in the city of Metz in northeastern France. He specialises in implantology and periodontology and has vast experience in performing invisible aligner treatments. We met with him to chat about all things dentistry − and here’s what we talked about.

Article March 01, 2022 “I feel that not only is the dental profession changing, but clinics cannot survive unless they reinvent themselves,” Dr Stephanus says. “That is what we aim to do at our clinic in Metz. All our dentists specialise in different fields, and the idea is to offer our patients a complete treatment path with different points of care, all inside the same clinic.”

Dr Stephanus knows from experience that patients expect more than ever before. “They want faster, less expensive, more aesthetic results. For some, it’s like ordering takeout – they want instant results and don’t want to come in for several sessions. So speed is key.”

To answer to these demands, the clinic is of course equipped with the latest technology. With 15 years of experience in practicing dentistry, Dr Stephanus finds it fascinating to think how the field has evolved in just the past 10 years.

“A decade ago, there were just a few dentists who were digital pioneers − now I don’t think a clinic could even function without a complete digital solution of some kind,” he says.

Patients really appreciate the difference According to Dr Stephanus, especially patients who are in their fourties and beyond appreciate new modern treatment technologies and are impressed by the rapidity of the evolution of the industry.

“They remember having traditional impressions taken and how uncomfortable it used to be.

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They can really appreciate the difference when we use Planmeca’s intraoral scanner.

We actually have two of them, and our plan is to systematically start using them for all treatments.

For now, we use them for inlays, onlays, single and multiple prostheses, aligner treatments and implantology. Intraoral scanners fascinated me already 12 years ago and I have been following their digital evolution since.”

The perfect profession for a practical person For Dr Stephanus, dentistry wasn’t a vocation at first. He started by studying medicine, but slowly realised there was something missing in his studies.

“I was missing the practical side. With French bureaucracy being quite complicated, you sometimes spend more time doing paperwork than treating patients. I have always been a hands-on person, and the dental curriculum struck me as very interesting. I found dentistry quite late in life, but it still became a passion.”

A good supplier is a dentist’s best friend Dr Stephanus came across Planmeca’s solutions when his clinic supplier, Olivier Leroy from Planmeca’s distributor Comptoir Dentaire Lorrain introduced him to the brand at the ADF dental fair in Paris.

“I am lucky to have a long-term supplier who is very skilled technically. Without him, I would have never embarked on this adventure. You need someone who is not only a good salesperson but also a good technician.

EQUIPMENT SOLUTIONS

Planmeca ProMax 3D - CBCT Unit

Planmeca Compact i5 - Dental Unit

It’s really important to find a person you can trust for advice, for installations and for upgrades.”

Dr Stephanus was immediately impressed by Planmeca’s solutions. “They struck me as more ergonomic, more logical and more practical than other products.”

He started by working with a 3D imaging system and gradually ended up purchasing dental units, CAD/CAM devices and accompanying software solutions from Planmeca as well.

“When I think about Planmeca, the words security, comfort and taking pride in innovation come to mind. I feel secure with their software and hardware, and I find their products to be pleasant and simple to use.

It’s a tangible brand, a company that goes to great lengths to constantly keep moving and innovating.

I think that might even be the reason that keeps me with Planmeca – if they don’t have something now, I know that they will have it soon.”

Great ergonomics on many levels

Impeccable infection control is imperative The clinic is also equipped with the Planmeca Compact™ i5 dental unit and Planmeca’s patient chair. “Their comfort is exceptional.

Everything is well thought out, and you can make so many adjustments. It’s great for us dentists and also for our dental assistants, who have easy access to all the different parts of the unit.

Our dental unit is also equipped with a monitor that we find super practical – we can show different things to our patients and keep the patient file open on the same screen.”

Dental unit infection control also receives a perfect score from Dr Stephanus. “You can dismantle everything and sterilise everything.

This is an imperative for every practice today, especially with Covid still being a concern.

We owe our patients impeccable infection control.”

Dr Didier Stephanus Mr Olivier Leroy from Comptoir Dentaire Lorrain

What makes Planmeca’s 3D units stand out, according to Dr Stephanus, is the great ergonomics they offer on different levels. “By ergonomics I mean several things.

The device is comfortable for the practitioner to use and less anxiety provoking for the patient. Patient positioning happens almost on its own. But by ergonomics I also mean the software: it is easy to understand and to manage.

More dental equipment solutions

DR DIDIER STEPHANUS

MR OLIVIER LEROY

I have used other software solutions that have been so cumbersome that using them almost became counterproductive.”

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EQUIPMENT SOLUTIONS

HOW TO COMPLY WITH CBCT RADIATION SAFETY REQUIREMENTS IN A RADIATION PRACTICE

Background Meeting the legislative requirements (licensing, procedures, and compliance) for a radiation practice can be daunting, not to mention a frustrating process. There isn’t clear ‘road signs’ or directions to help guide what to do.

Indeed, one can waste substantial time understanding these legal requirements, let alone applying them to practice.

Of course, you still require plenty of time and energy to run your business/practice.

All practices with a radiation machine (intra oral, extra oral, CBCT, laser) must comply with the local radiation health regulatory requirements for radiation safety.

The core purpose is to ensure the safety of everyone, not only for the people operating the radiation machine but also for people within proximity of the radiation machine/exposure.

As you know, radiation energy is invisible yet can impact health and wellbeing if not used correctly.

Each state and territory of Australia have their radiation safety guidelines and requirements. They differ both in applications and implications. Below are the relevant legislation and regulation governing the radiation requirements across Australia: Queensland – Radiation Safety Act 1999 & Radiation Safety Regulation 2021 New South Wales - Radiation Control Act 1990 &

Radiation Control Regulation 2013 Victoria – Radiation Act 2005 & Radiation

Regulations 2007 Western Australia – Radiation Safety Act 1975 &

Radiation Safety (General) Regulations 1983 South Australia – Radiation Protection and

Control Act 1982 & Radiation Protection and Control (Ionising Radiation) Regulations 2015 Tasmania – Radiation Protection Act 2005 &

Radiation Protection Regulations 2016 Australia Capital Territory – Radiation Protection

Act 2006 & Radiation Protection Regulation 2007 Northern Territory – Radiation Protection Act

2004 & Radiation Protection Regulations 2007 It is beyond the scope of this article to go through the legislative requirements of each state/territory in detail.

However, the above indicates the challenges of expanding your radiation practice into different states/territories. With every new branch you open, you must be familiar with the specific legislation and regulation for that state/territory.

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EQUIPMENT SOLUTIONS

The radiation legislative and radiation compliance requirements are not uniformed across Australia.

What is needed for a new CBCT machine?

There are two possible scenarios: (1) upgrading your existing OPG unit in an existing OPG room (2) furnishing a new CBCT room altogether.

As one can imagine and appreciate, this could get very confusing if you have multiple radiation practices across Australia.

Nevertheless, the following requirements apply:

Understanding the legislation can be particularly challenging for a start-up practice, especially if you are unsure what steps to take to obtain the appropriate licence and compliance requirements.

Some common issues include:

1. Apply for the appropriate radiation licence for the applicable state/territory for the CBCT machine.

1. Failure to apply for a radiation licence of the state/territory as required before the purchase and installation of the radiation machine

3. Develop a shielding report for the CBCT room.

The shielding report advises the builder of what type of shielding is needed for the room based on the workload, radiation output, dose limit, occupancy level and distance. This is required in all states/territories, even for an existing OPG room. Radiation energy from a CBCT machine is significantly higher than a standard OPG machine.

2. Develop a radiation safety management plan for the CBCT machine as required by the applicable state/territory.

2. No shielding report was performed for the radiation room 3. The radiation machines were not registered with the specific state/territory regulator

4. Register the new CBCT machine/s as the relevant state/territory requires.

4. No compliance testing was performed for the radiation machine and the radiation room.

5. CBCT machine compliance testing and certification by an accredited person as required by the relevant state/territory (e.g. QLD needs CBCT machines to be compliance tested annually. This requirement was introduced in September 2021 & NSW introduced new CBCT testing protocols).

Without obtaining reliable advice from a radiation consultant, making the above mistakes is highly possible.

This could trigger an audit/inspection from the radiation health regulator, creating unwanted stress and anxiety – certainly not what you wish to encounter when starting a business!

6. CBCT premises compliance testing and certification for premises by an accredited person as required by the relevant state/territory.

Not to mention, failure to adhere to the legislative requirements may attract significant penalties.

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An experienced radiation consultant (physicist) will be able to guide you through this whole process (from licencing, shielding assessment, compliance testing to ongoing radiation safety procedures).

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EQUIPMENT SOLUTIONS

The following are two prevalent scenarios: These scenarios outline what these radiation practices encountered when they chose not to work with an experienced radiation consultant.

Scenario 2

Scenario 1

•

• •

•

• •

•

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The radiation practice has been established and engaged in radiation operations for a few months They received a call from the Radiation Health Regulator arranging a walk-in audit and inspection The Regulator discovered that the radiation machines did not have current compliance certificates and that the business did not have the appropriate licences to possess/own/ operate the radiation machines The owner of the practice was not aware of this, as they had not received any professional advice The Regulator gave the business/practice owner 30 days to rectify, comply, or face further actions (fine or removal of x-ray machines). While the compliance process was underway, the business was not permitted to operate the radiation machines until they met all the legislative requirements. This caused a significant impact on business operations.

This is a very common scenario.

•

•

•

• •

•

The radiation practice has the appropriate licences to both possess/own and use a radiation machine The radiation machine was compliant, but the room in which the radiation machine was installed has no shielding report It is a requirement to have a shielding report for each room (for radiation use and compliance) The owner was unaware of this requirement.

In fact, they were told by the x-ray machine suppliers that the x-ray machine was low dose; therefore, no shielding was required However, this was incorrect advice by the radiation machine suppliers The radiation machine may have a low dose per exposure with high-frequency use. Thus, a shielding report must be generated for each radiation room – this is a requirement by each state/territory. A shielding report will determine whether shielding is required for the radiation room.

Calculations were undertaken - discovered that one wall of the room was under-shielded.

EQUIPMENT SOLUTIONS

• •

The business owner must rebuild the wall in question to ensure compliance The shielding report, rebuilding of the wall, and the shielding application to that wall cost the business owner time and money – a situation that could have been avoided with the correct advice from a radiation consultant.

Key Points •

•

•

•

It is crucial to follow all the correct procedures and processes for your radiation practice before operating radiation machines. If you operate radiation practices across Australia, be mindful of the different sets of legal requirements and compliance processes that you must adhere too Ensure that you have all the necessary licences, compliance certification, ongoing radiation safety and protection procedures for your radiation practice. Getting it right from the onset can ensure that you are confident come time for an audit and inspection visit from the radiation health regulator Make sure your radiation practice maintains ongoing radiation compliance - Any practice/ business owners do not wish to have their radiation practice/operation interrupted if they are issued with an improvement or action notice by the radiation health regulator Engage an experienced radiation consultant from the onset for your radiation practice.

The radiation consultant can also assist with ongoing radiation compliance for your radiation practice to avoid significant penalties by the radiation health regulator for non-compliance and address any radiationrelated matters (including relocation, sale, purchase, disposal, decommission, radiation incidents etc.)

Action plan for radiation compliance To ensure your radiation practice is 100% compliant with the law, engage an accredited radiation consultant (preferably with a radiation physics background) across all areas of radiationrelated matters. Working with a professional will help save time, prevent anxiety, and reduce costs and is a long-term investment.

This is particularly true when changes are made to radiation standards, procedures, and processes from time to time. Leaving radiation matters to an expert frees you to focus on providing stronger clinical work and developing your business.

NOTE: The investment costs are as little as 0.076% (over five (5) years - average compliance cycle) of an average annual turnover of a 3-chair practice with an extra-oral machine.

Choosing your radiation consultant Your radiation consultant should: •

Be an accredited consultant in the relevant state/territory

•

Have a solid working knowledge of radiation safety and compliance regime for the applicable state/territory

•

Be able to advise your radiation practice of the compliance requirements Articulate radiation safety and protection requirements effectively for the staff and clients at the radiation practice Provide foresight to ensure your radiation practice pass the radiation regulator’s audits and inspections Have a strong reputation in the radiation industry Respond efficiently to radiation-related matters, given that radiation breaches or incidents require immediate attention

•

•

• •

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

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EQUIPMENT SOLUTIONS

Interested in CBCT technology?

Do you need CBCT certification?

The 6th Australasian Digital Dental Symposium provides a tremendous opportunity to establish, develop and expand your understanding and use of all aspects of digital dentistry.

Register for our CBCT applications training videos and get your certification today!

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6TH AUSTRALIAN DIGITAL H AUSTRALASIAN DENTISTRY SYMPOSIUM ENTISTRY SYMPOSIUM

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DEN5/IA24 Certification / IA24 Certification These onlineDEN5 Applications Training provides These online Applications Training videos provides relevant releveant certification (DEN5/IA24 ascertification set out (DEN5/IA24) as set out by State Health and Radiation Departments to byenable State Health and Departments users to upgrade their extraRadiation oral licence to operate CBCT machines: to enable users to upgrade their extra oral licence to operate CBCT machines

S SCANNING

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CADCAM

2022 HAMILTON ISLAND, 14 CPD HOURS

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3D PRINTING

Please scan here to find out more WHITSUNDAYS about 6th Australian Digital Dentistry Symposium

Please scan here to find out more about the CBCT Applications Training Videos

EARLY BIRD REGISTRATIONS

WILLIAM TAN Director of Sieverts Radiation Protection Consultancy B.Medical Eng, Grad Dip App Sci

e future making everything more productive, precise and profitable. From CBCT (Medicaland Physics) CADCAM and 3D Printing, digital dentistry enables clinicians technicians to linical outcomes, patient experience and practice-profitability.

al Symposium 7 4provides a tremendous opportunity to establish, develop and se of all aspects of digital dentistry.

Please scan here and visit Sieverts Radiation Protection Consultancy website • Covering all 4 Cone Beam manufacturers: Morita, Planmeca, iCAT and KaVo • Scan and protocol selection

• Patient positioning • Scan acquisition

EQUIPMENT SOLUTIONS

DENTAL POWER TOWER

More and more installations of compressors and suction systems are close to the treatment rooms.

The basic performance is comprised of a reliable supply of oil-free, dry, and hygienic compressed air and powerful spray-mist suction.

This, coupled with less space for supply systems and tougher requirements for noise are the trends that push the demand for highly integrated, silent supply systems.

The compressor is equipped with modern membrane drying technology supplying even better dehydration of the air and an optimal performance capability is achieved – for up to 24 hours of non-stop operation.

The Power Tower Silence line from Dürr Dental has been developed for these exact needs.

In addition to low space requirements, the PTS 200 convinces with its quietness.

Suction and compressed air are combined in a tower, for up to 4 parallel operators at a maximum noise level no louder than a quiet conversation.

Thanks to the effective encapsulation of sound, only a mere 54 dB(A) of the running sound is heard.

Clean and hygienic compressed air is an important factor in dental treatment.

This property makes it ideally suited as a fully integrated practice level plant system.

The efficient filtering of particles and especially of microorganisms is gaining more and more attention.

Power Tower Silence combines compressed air and suction in a single housing.

Due to increasing quality standards, the new bacteria filter is now included in the standard scope of delivery of all Silver Airline compressors.

The compact, quiet supply unit can be installed flexibly in the surgery on a floor space of only 0.3 – 0.4 m2.

That saves valuable space compared with the installation of single appliances – a big advantage with present-day rental costs.

The bacteria filter is a high-efficiency air filter with the filter quality ULPA U16* respectively ISO 65U* and shows a retention capacity of > 99,99995% for particles ≤ 0,01µm The PTS 200/42 with network compatibility, features all advantages of the proven Power Tower Silence systems.

Find out more about the Durr Power Tower

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EQUIPMENT SOLUTIONS

CATTANI BLOCK-JET SILENCE

Blok Jet Silent is your ultimate compact plant-room solution. It houses both the oil-free, dry air compressor and centralized suction (with integrated amalgam retention system), operating silently to make the work environment comfortable for patients and staff.

The Blok Jet Silent has been designed with a small footprint to offer a viable solution to clinics with space restrictions, without having to compromise on performance or reliability.

The unit is fitted with lockable castor wheels for easy positioning and servicing. Access doors are also lockable for further security. The unit is equipped with an external Turbo SMART display, compressor pressure gauge, alarm lamps and an emergency stop button for easy access and monitoring. The cabinet has an integrated, thermostatically controlled cooling system to circulate cool, external ambient air through the cabinet, removing heat generated by the internal equipment. Available in one size which supports up to 4 simultaneous users.

To Further improve on our world-class air technology, Cattani now include HEPA H14 filters as a standard feature in all our AC compressor drying columns.

This also include the Block-Jet Silent range. Adding this new feature, Cattani deliver the finest dental grade quality air from our first-class equipment to the dental surgery.

Find out more about the Cattani range of compressors

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Space is valuable and, in many practices, strictly limited. There can also be issues with noise upsetting staff, patients, and even neighbours. Cattani understands this and has a range of compact solutions to eliminate the need for a traditional plant room for dental suction and compressed air.

The Cattani Blok-Jet Silent Range is your ultimate compact plant-room solution and has been designed with a very small footprint to offer a viable solution to clinics with space restrictions without having to compromise on performance or reliability. It houses an oil-free, hygienic, dry air compressor and an energy efficient, inverter controlled centralised suction system (with the added benefit of an integrated Hydrocyclone amalgam retention system). The ultra-quiet operation makes the work environment comfortable for patients and staff.

The cabinet has an integrated, thermostatically controlled cooling system to circulate cool, external ambient air through the cabinet, removing heat generated by the internal equipment to create the ideal environment for long-term reliability and optimal performance. The unit is fitted with lockable castor wheels for easy positioning and allows easy access for routine maintenance.

Access doors are also lockable for added security. The unit is equipped with an external Turbo SMART display, compressor pressure gauge, alarm lamps, and an emergency stop button for easy access and monitoring.

Available in two sizes, the Blok-Jet Silent 1 supports two users simultaneously, or the Blok-Jet Silent 2 that can support up to four users simultaneously.

DIGITAL SOLUTIONS

CERAMIC VENEER RESTORATIONS USING SMILE DESIGN AND DIGITAL WORKFLOW

Case information The patient is a 39-year-old male with no remarkable medical history or condition. The patient looked to achieve his specific aesthetic goals with the restorations, in terms of shape and shade of the teeth. He had previously had composite restorations on his teeth that he was not satisfied with. He wanted a better and longer lasting outcome.

Treatment Plan The treatment plan was to firstly carry out a comprehensive analysis of his smile and to show the patient what the expected outcome would be. We would then carry out some bleaching of his teeth, followed by six upper ceramic veneers and four lower ceramic veneers.

Initial consultation At the initial consultation, photos and pre-operative intraoral scans with 3Shape TRIOS were taken. After a brief discussion with the patient, the photos were imported into the 3Shape Smile Design module and a smile design was carried out. Figure 1 - 3.

Teeth were selected from the smile library and modified to suit the desired outcome. The photorealistic rendering was used to show the patient what the final result would look like.

This included a simulation of the lower teeth as well, which was invaluable as the patient was also wanting to the address the minor shape and rotation issues with his lower incisors.

Once the patient approved the smile design, this was transferred into 3D using CAD software and a 3D printed model for the patient’s final approval.

Figure 4 -7.

Tooth preparations were carried out on the upper six anterior teeth and four lower incisors and intraoral scanned.

Good retraction and a dry working field is essential for an accurate intraoral scan. Figure 8-10.

Provisional restorations were made using the 3D-printed model and a putty key. The provisional restorations were finalised and adjusted clinically, and then scanned again and sent to the lab to act as the final tooth position guide for the definitive restorations.

The lab technician, Mr. Sho Kurashige, designed the ceramic veneers in 3Shape Design System, and lithium disilicate veneers milled and finally finished by hand on 3d printed master models. Figure 11-14.

The lithium disilicate veneers were then tried in and bonded using a resin cement.

The accuracy of the 3Shape intra-oral scanner and the precision of the technical work ensured a perfect fit of the restorations.

The result was near-identical to the initial smile design, so what was initially planned was able to be delivered to the patient with no surprises or compromises. Figure 15-17

The patient then had bleach trays fabricated and began to bleach his teeth using carbamide peroxide gel for 2 weeks. The teeth were then left for a further 2 weeks to settle and to ensure that the resinenamel bond strengths would return to normal.

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DIGITAL SOLUTIONS

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Figure 1 – original oral situation

Figure 2 – original smile

Figure 3 – smile simulation with 3Shape Smile Design

Figure 4

Figure 5 - Pre-existing tooth library forms customised to suit the clinical situation

Figure 6 - Photo-realistic rendering of the lower incisors to show the patient what could be achieved

Figure 7 3D - printed model of the digital wax-up, based off the smile design

Figure 8 - Upper teeth prepared and retracted ready for scanning

Figure 9 - Lower teeth prepared and retracted

Figure 10 - Intraoral scan of preparations

Figure 11 - Provisional veneers were made from the diagnostic model

Figure 12 - Patient approved temporaries scanned and imported into 3Shape Dental System

Figure 13 - Upper veneers on 3D-printed model

Figure 14 - Lower veneers on 3D-printed model

Figure 15 - Veneers in situ

DIGITAL SOLUTIONS

Figure 16 - View of lower veneers, showing a very close match to the initial simulation

Figure 17 - Final smile

Summary

Discussion

The Smile Design module was able to help the patient and dentist get an accurate representation of the final aesthetic outcome of the planned anterior veneers. This was beneficial with ensuring the dentist understood what the patient’s aesthetic goals were, and to demonstrate to the patient what could be achieved.

Using the digital workflow, the entire process was streamlined and efficient, and the patient’s expectations were able to be met.

The digital workflow has significant advantages over the traditional analogue workflow, in that many processes are now quick and efficient. The ability to show the patient a photo-realistic rendering of the proposed final outcome at the very first consultation is invaluable for case acceptance.

Being able to import the smile design simulation into the CAD design software also ensures that the initial design can be accurately copied. The entire case is then able to be completed with a clearly defined endpoint, leading to no surprises for the dentist or the patient.

The benefits of the digital workflow according to Dr. Chang •

About Dr. Chee Chang

The Smile Design module is quick and intuitive, allowing for the patient to already see ‘results’ at the very first consultation. This was beneficial with case acceptance.

•

The most recent version of the Smile Design module now allows for smile design to be carried out in the lower teeth.

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The digital workflow enabled multiple scans to be sent to the technician easily and quickly, including the pre-operative situation, the patient approved temporaries, and the actual tooth preparations themselves.

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The digital images of the smile design and the digital models are all able to be virtually superimposed and cross-arch mounted, which enables the technician to accurately design the final restorations to the dentist’s prescription

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The accuracy of the TRIOS ensured a perfect fit of the restorations, with no or minimal adjustments during delivery.

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The accuracy of the 3Shape intra-oral scanner and the precision of the technical work ensured a perfect fit of the restorations.

•

The result was near-identical to the initial smile design, so what was initially planned was able to be delivered to the patient with no surprises or compromises. Figure 15-17

Dr. Chee Chang trained at the University of Otago (NZ) graduating in 1999. He then joined Welling- ton Hospital In the capital city of Wellington, New Zealand and worked as a dental house surgeon where he further developed his skills in oral surgery and management of complex medically com- promised patients. Following this, commenced work in private practice in Auckland, and would later relocate to the UK where he worked in Somerset county and in London.

Chee completed a postgraduate diploma from the Royal College of Surgeons (UK) in 2006 in advanced general dentistry. He later returned to New Zealand to undertake specialist training, finishing in 2009. During this time, Chee completed his research thesis on dental ceramics, and has published in the Journal of Prosthodontics.

He has maintained teaching positions at both the University of Sydney and Melbourne University. Chee lectures regularly to dental students, dentists and other dental specialists on all aspects relat- ed to prosthodontics and implant dentistry. He is a frequently invited speaker at conferences, both in Australia and overseas, and is a key opinion leader for a number of dental companies.

DR. CHEE CHANG

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DIGITAL SOLUTIONS

CAD/CAM RESTORATIONS MONOLITHIC, TIME-EFFICIENT FRONT TOOTH RESTORATIONS

Often, patients desire time-efficient CAD/CAM restorations that simultaneously feature a natural play of shade and light.

This requires materials that are suitable for both monolithic, time-saving CAM-based production and characterized by excellent light dynamics. VITABLOCS TriLuxe forte feldspar ceramic (VITA Zahnfabrik, Bad Säckingen, Germany) is such a material. The third VITABLOCS generation has an integrated, finely nuanced shade and translucency gradient and can be efficiently and precisely processed, thanks to its finely structured ceramic.

Using the design software, the restoration can be placed in the virtual blank so that the play of shade and light can be controlled individually for each patient. Dr. Julio Gomez Paris (Rosario, Santa Fe, Argentina) uses the example of a total reconstruction with veneers to show how he was able to to efficiently create a restoration with this polychrome material.

Assessment and material selection A 72-year-old woman came to the practice because she was not satisfied with the esthetic appearance of her teeth. The clinical inspection revealed severely abraded and erosively damaged anterior teeth with exposed root areas. The patient wanted to have the lost hard tooth substance reconstructed while rehabilitating the esthetic zone with veneers. The desired situation was simulated on the computer using patient phots and discussed with the patient.

For efficient, natural dental esthetics, VITABLOCS Tri-Luxe forte was chosen as the material.

Mock-up and scanning process The patient was symptom-free from a functional point of view. The habitual intercuspation showed no deviation from the centric condylar position, which is why impressions of the upper and lower jaws were taken, and models were produced and articulated by means of a bite registration. In the articulator, the bite was raised by one millimeter and a functional esthetic wax-up was performed. With a silicone key and temporary composite material (Protemp 4, 3M, Seefeld, Germany), this idealized situation was transferred to the patient’s mouth and a fine adjustment made directly in the patient’s mouth. The final situation was scanned for virtual construction with the CEREC Omnicam (Dentsply Sirona, Bensheim, Germany). Initially, the posterior region was first treated with crowns and partial crowns made of VITABLOCS TriLuxe forte in the shade 1M2.

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After the bite had been stabilized in the posterior region, the veneer restoration could be started.

Digital construction and production After local anesthesia, a mock-up guided gingivectomy and controlled preparation were performed. The preparations were scanned and the data record transferred to the inLab CAD software (Dentsply Sirona, Bensheim, Germany). There, the maxillofacial veneers were first designed for the patient based on the mock-up scan and fabricated using the inLab MC X5 grinding unit (Dentsply Sirona, Bensheim, Germany). After finishing with a fine diamond and a rubber polisher, the characterization and the glaze followed with the VITA AKZENT Plus stain system.

Final result: total reconstruction After a successful try-in, the veneers were conditioned with hydrofluoric acid and silane. The preparations were etched with phosphoric acid, and the universal adhesive Scotchbond Universal was applied. Adhesive attachment was carried out with RelyX Veneer (both 3M, Seefeld, Germany). The restoration of the lower jaw incisors was done in the same manner. The patient was very satisfied with the efficient and highly esthetic result.

To relieve the stomatognathic system and to protect the restoration, a front canine-guided splint was additionally made for the night. At a follow-up after a year and a half, absolutely stable conditions were found.

DIGITAL SOLUTIONS

Fig. 1: Initial situation: Due to abrasion and erosion, an irregular contour of the incisors had developed.

Fig. 2: Multiple recessions had led to an uneven alignment in the gingival garlands.

Fig. 3: The functional-esthetic mock-up was transferred with a silicone key.

Fig. 4: The composite mock-up during the check of the dynamic protrusion.

Fig. 5: After prosthetic stabilization of the posterior region, the mock-up was prepared.

Fig. 6: The substance was removed in a controlled manner and as minimally invasive as possible.

Fig. 7: The scanned preparation in the upper jaw in the CAD software.

Fig. 8: The virtual construction of the upper jaw veneers from VITABLOCS TriLuxe forte.

Fig. 9: The virtual construction of the veneers in the lower jaw.

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DIGITAL SOLUTIONS

CAD/CAM RESTORATIONS CONTINUED

Fig. 10: Characterization was done using the stain system VITA AKZENT Plus.

Fig. 11: The veneers produced with CAD/CAM support in the upper jaw immediately after adhesive integration.

Fig. 12: The veneers in the lower jaw directly after the adhesive integration.

Fig. 13: In the upper jaw, the gingivectomized areas were already healed.

Fig. 14: A front canine-led splint was integrated after the total reconstruction.

Fig. 15: After a year and a half, the conditions were absolutely stable.

Fig. 16: The incisal edges harmonized with the curve of the lips.

Fig. 17: The efficiently fabricated veneers appeared absolutely natural.

Fig. 18: The excellent light dynamics of the material enables a highly esthetic result.

VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

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DR. JULIO GOMEZ PARIS Santa Fe, Argentina

PROSTHETIC SOLUTIONS

BRILLIANT CRIOS BY COLTENE THE FABRICATION PROCESS OF A CAD/CAM CEREC CROWN

The application fields of the new composite bloc include crowns, inlays, onlays and veneers as well as implant-supported crowns. BRILLIANT Crios is a reinforced composite bloc for the fabrication of permanent restorations using a CAD/ CAM milling process.

Due to the loss of the full ceramic crown, the patient was willing to have a new restoration fabricated using a CEREC crown made of the new compositebased BRILLIANT Crios (COLTENE) CAD/CAM material. The existing tooth stump 37 required

This is available in Low Translucent (LT) and High Translucent (HT) shades and in sizes 12 and 14.

The material properties allow extended processing: easy preparation, tapered margins and polishing. In addition, the BRILLIANT Crios bloc can be repaired with methacrylate-based composite materials. As part of material sampling, a 34-year old patient in this case required a newly fabricated restoration after losing a full ceramic crown due to fracture.

The patient presented with a missing restoration on tooth 37. The X-ray of the untreated stump (Fig. 1) shows the tooth with a root filling and a composite abutment post (this restoration was performed by a different dentist).

• • •

additional preparation to meet the following criteria: Minimal occlusive thickness 1.5 mm Minimal buccal thickness 0.8 mm Minimal thickness under supporting cusp 1.5 mm

• Minimal cervical thickness 0.8 mm Occlusal corrections and additional preparation of the transitions to the distal stage were required in this case.

The existing deep distal stage on tooth 37 also proved problematic in this clinical situation. We therefore decided on a squeeze bite impression with an A-silicone (AFFINIS, COLTENE) as experience

Due to the loss of the full ceramic crown, the patient

Fig. 1: Initial situation, single X-ray of tooth 37

FIG. 2: Plaster model with prepared tooth stump 37

Fig. 3: Milling bloc BRILLIANT Crios, colour shade A2 HT

Fig. 4: Milled crown with residual lug (separation point from bloc)

Fig. 5: Crios crown on plaster model

Fig. 6: ONE COAT 7 UNIVERSAL is applied to the bonding surface of the crown and rubbed in with a dental brush for 20 s.

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PROSTHETICS SOLUTIONS

BRILLIANT CRIOS BY COLTENE CONTINUED

has shown direct optical impression taking to be very difficult in such situations. With the aid of the subsequently fabricated plaster model (Fig. 2), it was quite easy to take the optical impression for fabricating the CEREC crown. The BRILLIANT Crios bloc used for milling the full crown is shown on the photo (Fig. 3, shade A2 HT).

A check of the precision fit on the plaster model was good (Figs. 5 + 7), so that we decided to try-in and then place the restoration on the patient. To ensure bonding between the mounting material and the milled restoration, use ONE COAT 7 UNIVERSAL bond (COLTENE) only. An etching step with hydrofluoric acid is not necessary.

At the time of preparing this report, there were only two milling programmes available from other manufacturers for processing composite blocs in the CEREC system. In future, there will be an own COLTENE BRILLIANT Crios milling programme by the Sirona company available for use in the CAD software.* In our case we chose the programme GC Cerasmart 14. Presently, the Crios bloc can be milled with this Sirona programme. (A further possible programme is the 3M ESPE Lava Ultimate). The bloc available to us was size 14, in future a bloc size 12 will also be available.

ONE COAT 7 UNIVERSAL was applied to the sandblasted and cleaned mounting area of the restoration and rubbed in for 20 seconds (Fig. 6).

Construction and milling of the crown leads to the following result (Fig. 4). Compared with ceramic materials, for example IPS Empress (Ivoclar Vivadent), the surface structure of the ground crown appears very smooth and the residual lug is smaller after milling. This facilitates its removal with a diamond and nothing remains visible after brief polishing. Polishing can be performed after milling using a conventional rotary polisher or milling paste. The crown in question also passed the check for cracks or material chipping.

Fig. 7: The finished BRILLIANT Crios crown on the plaster model in occlusion

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Excess adhesive was removed with oil-free compressed air for 5 seconds. Bonding to the tooth substance and/or composite can be carried out using a suitable adhesive. ONE COAT 7 UNIVERSAL Bond is recommended here (procedure according instructions for use). We used this adhesive throughout in our case.

Prior etching of the enamel areas with phosphoric acid is recommended and was carried out by us.

For bonding of the restoration, a dual-curing resin cement, i.e. DuoCem™ (COLTENE), or a light-curing composite can be used.

The BRILLIANT Crios crown is now ready for insertion. After bonding our full crown with DuoCem™ (COLTENE), the edges were cleaned, excess was removed, and then every surface of the restoration was light-cured for 30 seconds (light output > 800m W/ cm2) and then worked on with a rubber polisher.

Fig 8: Clinical situation after placement and polishing

Fig 9: Follow-up after 4 weeks

PROSTHETICS SOLUTIONS

Milling of the occlusion proved simple and quick.

The gloss of the entire composite crown already appeared after a short time. Furthermore, when readjusting the occlusal contact points, we were able to polish immediately, which is much more difficult to do with ceramic, and in particular, with fired crowns.

CAD/CAM restorations made from the new Crios blocs can be characterised, modified or also repaired at any time. Modifications can be made directly without prior treatment. In case of intraoral repairs, the restoration surface is cleaned with cleaning paste, and then roughened using a diamond rotary instrument. In both cases, ONE COAT 7 UNIVERSAL is applied to the surface to be treated and cleaned with compressed air for 5 seconds. This is followed by light-curing for 10 seconds (also see instructions for use ONE COAT 7 UNIVERSAL). Colour shades or composite (i.e. BRILLIANT Ever- Glow, COLTENE) are then used afterwards according to the respective manufacturer’s instructions.

The material discussed for the fabrication of a CEREC crown is a composite with the following technical features. The flexural strength and the modulus of elasticity are represented in the following graphs.**For comparison purposes, the ceramic and composite materials of other manufacturers were used. The good flexural strength and the e-modulus, which is similar to dentine, make the material more elastic than ceramic.

Conclusion Handling is conveniently simple and the clinical result after placement and 4 weeks later is very good (Figs.

8 + 9). The following points result in time saving and “service benefits” versus ceramic restorations: •

No firing of the restoration required (i.e. as with IPS e.max CAD).

• Gloss of the composite is easy to achieve, also much easier than with IPS Empress CAD. • No etching with hydrofluoric acid or silanisation necessary.

• If required, repairs with composite are easy to realise, analogue to a filling.

• Dentin like e-modulus, less brittleness than ceramic.

Long-term studies are necessary to compare the clinical results with ceramic materials. In terms of application, this material proved excellent.

The patient was very satisfied with the result and praised the pleasant wear comfort of the composite restoration versus his previous ceramic crown immediately after treatment. Next, we would like to attempt restoration of an implant with a single crown.

DR. CHRISTOPH G. HÜSKENS med. dent.

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Scan here to view to view graphs mention in the article

Scan here to view the BRILLIANT Crios range on our website

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

NEW PRODUCTS

GC MODELING LIQUID APPLY, SHAPE, SMOOTH, ENJOY

Simplify your composite work using GC Modelling Liquid with your brush or Instruments With the right tools, a smooth and well-sculpted direct composite restoration is achievable, resulting in a nice aesthetic outcome. Using GC Modeling liquid and a brush or instrument to composites is a true game changer.

Also great for posterior cases, helps build the cusps and refine the design of the fissures. GC Modeling liquid becomes fully transparent after light-curing, giving nice aesthetic results.

Dispense one drop of GC Modeling Liquid on a pad.

Use it quickly and protect it from the light with a cover.

Touch the drop with the brush in order to moisten it.

Remove the excesses thoroughly using a paper tissue.

Use a flat brush to create a palatal enamel shell.

A round brush can be useful to create the interproximal part.

Apply the dentin paste using the flat brush.

Model the dentin mamelons using a round brush.

Model the dentin mamelons using a round brush. Thanks to the brush, the final layer will have a smooth surface.

Find out more

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NEW PRODUCTS

ONE RECI: SINGLE FILE IN RECIPROCATING MOTION

MicroMega One RECI is a single-use reciprocating instrument for root canal shaping.

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Cutting efficiency: Patented Asymmetric Cross-Section Safety: Cyclic Fatigue Resistance Minimally invasive: preservation of peri-cervical area and dental hard tissues Single file | Sterile blister packs 5 sizes (20/.04, 25/.04, 25/.06, 35/.04, 45/.04) 3 lengths: > 21 mm > 25 mm > 31 mm Complete your treatment procedure with the One RECI Gutta Percha & Paper Points

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NEW PRODUCTS

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Dual Move Motor Cordless endodontic motor with well-balanced, in-hand, silent endodontic motor for control of movement, speed and torque, offering freedom, comfort, and optimal security when shaping the root canals. Display turns around in order to suit to left-handers, and contra-angle rotates without being disconnected from the handpiece. Miniature head and thin neck make it easier to reach the posterior teeth while keeping excellent visibility on the root canals inlets and working area.

Portable motor for perfect adaption to individual needs and practices. Prevention of file separation, control of speed and torque, and correction of possible gradual drifts through auto-calibration, for safe endodontic treatment

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CanalPro Endodontic Solutions When it comes to irrigating, CanalPro Endodontic Solutions are your best choice for successful treatment. We have engineered our endodontic solutions to minimize the time spent on irrigation, giving you the best approach to cleansing canals and the BEST OUTCOMES. For irrigation/debridement of root canals during and after instrumentation Available in MM-60019655V

CanalPro NaOCl 3% 500 ml Bottle

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NEW PRODUCTS

ENDOFLEX™ C-FILES & EUROSEPT XTRA WATERLINE

These files assist with locating the root canal and are recommended for calcified, curved, and narrow canals.

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Assists with locating the root canal

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EUROSEPT XTRA Waterline 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.

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EuroSept Xtra Waterline K6 water treatment is used to control the microbial population and prevents biofilm formation.

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EuroSept Xtra Waterline K6

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Active ingredient:

Active ingredient:

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Hydrogen Peroxide

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