The Dental Products We’ve Left Behind (and What’s Replaced Them)

I was recently introduced to VisCalor bulk by VOCO. Previously, I was using TPH Spectra® from Dentsply Sirona as my universal composite and Ivoclar Vivadent’s Tetric EvoCeram® as a bulk fill restorative option. I was initially hesitant to make the switch due to my loyalty to these excellent products, but after a colleague’s recommendation, I decided to give VisCalor a try.

I’m glad I did! It has given us excellent results. Some features that make this product a great choice are the narrow cannulas and the marriage of the composite warmer and the thermoviscous technology. VisCalor bulk is easy to place, polishes well, and adapts extremely well in hard-to-reach preps. These attributes give the resin the ability to flow and adapt well, which is clearly evident on Class II restorations when you remove the sectional matrix. I am happy to say I have seen a significant improvement over my previous restorative protocols.

The VOCO composite warmer—provided as part of the system—has 3 temperature options. For a larger dental office with multiple dentists, the flexibility allows each provider to use it how they prefer. The previous composite warmer we used only had 1 setting, which made composites too hot and therefore not ideal for sculpting. The medium temperature setting seems to be the sweet spot to achieve ideal adaptation and shaping/carving parameters for good restorative dentistry.

Another key feature is having a universal shade that blends well for posterior esthetics. I was surprised how it still retained opacity to cover discolorations in teeth, which is a common issue with the bulk fill resins I have used in the past.

One thing to note about this product is that VisCalor bulk is intended and required to be used with the VOCO composite warmer or dispenser gun. It is a very difficult material to extrude when using the Cavifil version without heating the product.

Overall, VOCO’s VisCalor bulk has performed extremely well for us, and I am happy I switched to this for our bulk fill restorative needs. VOCO is a premium brand in the dental industry but seems to fly under the radar. With this product I believe they will do very well. Innovation is a key part of our practice, and we look forward to trying future VOCO products.

I was taught in dental school to use cast post and cores with divergent preparations that removed undercuts and sacrificed significant tooth structure. There has been an ongoing trend in health care to be as conservative as possible and remove only diseased tissue. Endodontists now try to be as conservative as possible with their access openings. Restorative dentists should continue that treatment mode by using the smallest fitting posts possible.

Throughout the years, my postendodontic treatments have evolved from cast metal posts to prefabricated metal posts to glass fiber posts. I like fiber posts because they have an elastic modulus similar to dentin, which decreases the likelihood of catastrophic root fractures. The color of the underlying post must be considered because most crowns being placed today are completely ceramic.

I have been pleased with the results of the DT Light-Post Illusion® X-RO® posts from RTD Dental, but sometimes I enlarge the post space to increase the surface area of the supragingival core portion of the post for better bonding to the core material. I also may enlarge the post space further down the root to increase the retention of the post in the coronal portion of the canal space. More tooth structure is removed when a larger post is used, and internal ledges may be created, which can increase the risk of cracked roots.

Ideally, the post and core should be strong, without being too rigid, and still remove minimal tooth structure. The dilemma is that a traditional smaller-diameter post preserves tooth structure but requires a large, weaker composite core with less surface area to bond to the post. The coronal portion of the canal is surrounded by a large volume of cement that is weaker than the post material.

Since the COVID-19 pandemic began, we have employed a number of temporary staff. When multiple post and pilot drills are used, items tend to become misplaced or lost. It can be frustrating to search all over the office for missing drills and eventually have to make treatment decisions based on what you can find.

I found a simple solution for these challenges. Splendor Single Adjustable Post (SAP), from Angelus® has only 1 narrow size (0.65 mm apical / 1.0 mm coronal), and 1 drill in order to minimize inventory and discourage overpreparation of the canal. Splendor SAP lets the clinician adapt the fiber post to the canal flare with an adjustable, vertically sliding conical sleeve when it’s needed. The sleeve is made of the same radiopaque, fiber-reinforced composite as the post. It slides onto the post, converting the pointed, parallel post into a custom-fit post in a flared canal.

I bond the post and sleeve using BISCO’s Z-Prime Plus™ on the post and sleeve, BISCO Universal Primer™ on the dentin, and Core-Flo DC Lite™ as the bonding cement and remaining core buildup.

The flexural strength (1200 MPa) of the post is strong, and so the core is significantly stronger than unreinforced composite buildups. Splendor SAP is available in a package of 5 posts and sleeves, which makes it reasonable to try as opposed to investing in a large multiple-sized post kit.

The Splendor SAP fiber post system allows me to use 1 drill and 1 post, simplifying my supplies and ensuring I will have the necessary sizes in the office. I can conservatively place post and cores without removing excess tooth structure. Finally, I have a strong core by reducing the volume of weaker composite core material and increasing the amount of stronger fiber reinforced composite material. I have changed to the Splendor SAP fiber post system and recommend that you try it as well.

My husband and I are both dentists at NYC Smile Design. We take a lot of pride in staying up-to-date with the latest technology and providing the best experience possible for our patients.

That applies not only to clinical technology but also to the business infrastructure. Recently we upgraded our payment processing system to Simplifeye Payments. As a fee-for-service practice, we needed a system that makes it easy for patients to pay and for us to track the transactions.

Simplifeye Payments has a lot of features we like. It has a portable card reader so patients can pay from anywhere in the practice. One patient commented on how convenient that was.

Our patients like being able to tap their card instead of having to insert it or swipe it. They also like the ability to pay via Apple Pay or Google Pay, or by having funds transferred from their bank account via ACH.

We do in-house payment plans for some orthodontic cases, and Simplifeye lets us set these up with a card on file so we can automatically deduct the payment. That’s a nice change from having to ask for the credit card at each visit. Most of our patients prefer having the card on file because it’s convenient, and the information is tokenized so it’s secure.

We also like being able to run soft-pull credit checks to confirm the credit-worthiness of the patient before offering a payment plan. We’ve been in business for a long time and remember when a paper slip had to be completed to approve the payment plan terms. Now it’s all digital and patients can access it online whenever they want.

We collect payment for most procedures a week in advance. Simplifeye can send a text reminder with a link that lets patients pay online or from their cell phone. It also sends out automated payment plan reminders. We used to have to set reminders for ourselves to remember to follow up on collections.

The Simplifeye dashboard is clean and easy to use. Our office manager, Stephanie Yan, has been with our practice for 17 years and likes how easy it is to look up patients by name and see all their transactions. With our previous system, she would have to filter transactions by the day it was charged, and it would be time-consuming to find the right one. With Simplifeye, she can quickly see the charges and which one belongs to each patient.

We’re always looking to improve our efficiency and customer service. This is 1 way we’re making things easier for both our patients and for our team.

Looking back to when we used film, sometimes I wonder: How did we diagnose?

Imagine this: Just to take 2 full-mouth series, first you’d have to make sure your developing solutions were at the right temperature, 55-70 °F. After taking the x-rays, you’d have to change all the chemicals for the next series. These chemicals were highly temperature sensitive and processing sensitive, and they didn’t have any indicator to show when they were done. You’d have to guess and hope for the best.

At my practice in Pittsburgh, Pennsylvania, especially with our winter snowstorms, keeping the chemicals in ideal conditions was a problem. Sometimes the power would go out overnight at the office, and then when you’d run a full mouth series the next day, you couldn’t read it because the developer had been ruined. The images would come out too light, too dark, too wet—just a cluster of problems.

But if everything went right and, against all odds, your image develops nicely, you were still looking at an image approximately the size of a quarter. Today, you’re looking at an image that’s the size of your television.

You want to talk about prayers answered? That’s digital radiography.

In 2006, my practice switched over to digital x-ray sensors, and the difference was truly night and day. Most recently, we’ve been using the Clio Prime digital x-ray sensors by SOTA Imaging, and we’ve never looked back.

Gone are the days of worrying about processing times and losing money on wasted chemicals and poorly processed images. We no longer have to make awkward calls to patients asking them to return to redo their imaging because our staff ran multiple series and can’t tell which patient they’re for.

All our images are digital and uploaded to the cloud, so we never have to worry about archiving, storage, or having to rent office space just for image developing.

With digital x-rays, we’re actually able to see cavities with a level of detail that lets us plan the best treatment for our patients. Imagine that: being able to see the details of the images—what a time we’re living in.

Our sensors capture the clearest images with options for enhancement, which means more shades of gray to see the patient’s teeth in greater detail, which means a better diagnosis. It’s a win-win for us and for our patients.

Digital x-ray sensors make dentistry better for patients, better for our diagnostic abilities (and in turn, our professional reputation and patient trust), and better for the environment.

I want to share our practice’s experience with a fantastic product line that has changed our pre- and postoperative protocols for periodontal surgery. William Carter, DDS, has been performing tissue grafting, bone grafting, periodontal procedures, and implant placements for more than 40 years, and in the practice we have noticed a significant change in the outcomes of tissue healing after using StellaLife® recovery kits, rinses, and gel.

In the past we used chlorhexidine, which not only stains the teeth but also kills both the good and the bad bacteria—not ideal for the patient’s appearance or cell regeneration. Some patients would even end up with thrush from overuse. Using StellaLife does not destroy the good bacteria; it keeps it intact to promote faster healing. As a bonus, it tastes better and doesn’t stain the teeth.

StellaLife products are naturally antimicrobial and help reduce inflammation, which results in less use of pain medication. We found the rinse to be a good maintenance for controlling bacteria, and we believe it performs better than most of the rinses on the market. We also use the gel immediately after extractions, implants, tissue grafting, and osseous surgery. Our patients who previously experienced surgery without this product have commented on how much better they feel postoperatively after using it, and they even purchase the rinse from our office before surgery. I can honestly say this practice loves it.

The employees of this office all use the product for our daily rinse at home, and even the doctor’s wife won’t go without it. During the COVID-19 pandemic, practices began using the rinse during their preprocedural protocol. StellaLife’s rinse has a 2-minute swish kill of the coronavirus of more than 98%. We use the hand sanitizer for patient use in office as well as our personal care.

Our office loves StellaLife products, and we highly recommend them to our colleagues and patients.

I own and operate Imagine Dental, a growing general family dentistry practice started in 1996. We are located in Gardner, Kansas, approximately 30 minutes southwest of Kansas City, Missouri. We strive to provide premium dental care for our community in a comfortable office setting, using only the highest quality materials and technology.

My first adventure with chairside milling solutions began in 2004 with CEREC. I utilized the technology extensively for 5 to 6 years and then took a break for a few years to explore the new ceramics available through traditional dental laboratories. Chairside restorative material options were limited at the time, and I wanted to ensure my patients were receiving the very best restorations with optimal strength, esthetics, and quality. I returned to chairside milling with Amman Girrbach’s Ceramill® just before the COVID-19 pandemic hit, but I had little success. In early 2021, I decided to give chairside milling another shot and purchased DGSHAPE DWX-42W chairside milling solution from Roland DGA. I had done quite a bit of research, and the deciding factor for me was that the DWX-42W is a solid, reliable chairside milling solution built by a great company with an extensive history of innovative technology and experience in this space.

Using our DGSHAPE DWX-42W, we now schedule 2 hours from start to finish for a same-day chairside restoration. The DWX-42W has easily integrated into my existing digital dental workflow. I scan chairside, design the restoration in exocad DentalCAD software, nest it in MillBox, and send it to the DWX-42W to mill. The flexibility of DGSHAPE’s open-architecture platform allows me to utilize my material of choice based on my patients’ individual needs and circumstances. Currently, my preferred material is Straumann® n!ce®, which provides optimal restoration esthetics and strength, and mills in approximately 28 minutes with my DWX-42W.

From a patient experience and productivity standpoint, it is great to be able to deliver a restoration in an all-in-one, easy appointment. Patients appreciate the convenience of having only 1 appointment, and I don’t have to worry about temporaries coming off prematurely. My patients also report less postop discomfort and sensitivity with same-day crowns. In addition, because insurance claims are typically sent on the day a crown is seated, we are able to decrease the insurance reimbursement cycle time.

Although there may be other solutions that can offer all-in-one scanner, CAD/CAM, and mill packages, I like having digital dental solutions that are independent of one another, allowing me to easily integrate and interchange them as needed into my digital workflows. I can schedule staggered appointments and treat multiple patients throughout the day, optimizing my productivity while continuing to provide my patients with the very best dental restorative care.

Of all the mills I’ve worked with over the years, the DGSHAPE DWX-42W is by far the quietest, and it was also the easiest to integrate into my workflow. The DWX-42W consistently mills quality restorations with its advanced features, reliable operation, and precise milling tools. Its various diamond tools also have the longest wear times of any of the chairside mills I’ve used. In addition, the DWX-42W’s VPanel management software allows me to monitor milling tool life, so I can avoid diamond breakage in the middle of a restorative case. By using the DWX-42W, I can provide my patients with the best possible restorations while maximizing my overall return on investment.

When our office was shut down last year due to the COVID-19 pandemic, I began an exhausting and frantic search for personal protective equipment (PPE). As the pandemic spread, PPE supplies were quickly dwindling from all the usual sources. This was before the prices radically jumped. I back-ordered disposable gowns, cases of gloves, face shields, and masks from anywhere I could find them. I was able to obtain a few N95 face masks, and I advised my small team to wear level 3 surgical masks over them and a face shield on top of that. My hygienists and assistants wanted to be safe when we resumed operations at our northeast Tennessee office in early May 2020 while most of the country was still in limbo.

A group of local dentists had face shields 3D printed and shipped in bulk. I eventually was able to get traditionally manufactured face shields for my team, and they liked them much better than the bulky 3D printed variety. However, I ran into a problem. I wear SurgiTel® 3.5× prism loupes with a nano headlamp that has the battery attached. I also have started wearing surgical caps. The traditional face shields would not fit with my headgear, so I was left searching. I tried other face shields, including one that looked like the “cone of shame” the veterinarian had given our dog. Not one of them was comfortable for long periods of time.

Every shield I tried was unstable or just did not work well with a bulky loupe setup. After nearly a year of wearing my heavy “space alien” 3D printed shields, I stumbled upon a new face shield from Ambience® PPE. The face shield was developed by a dentist and his son. It looked promising.

The headband is based on the inner part of a hard hat. It is comfortable to wear with or without a surgical cap. The highly adjustable face shield is durable and lightweight. The shield arms can be moved to accommodate almost any loupe and light system. I have banged the nano surface optical visor into several cabinets, walls, and lights when I forget I am wearing it and have yet to scratch it. The shield can be flipped up when speaking with patients for clearer communication through layers of masks. When my office increased air filtration during the pandemic, it created more background noise, so it is appreciated when I don’t have to speak louder for patients to understand me. As the number of Delta and Lambda variant cases increase in my area, my patients can feel more at ease that we are implementing necessary safety measures.

The owners of Ambience PPE are easy to communicate with and helpful when you have any questions about their product. After several months of using the Ambience PPE face shield, I would highly recommend this face shield to any of my colleagues.

When a product name becomes shorthand for the material, it’s clearly become a legend. Such was the fate of 3M™’s Cavit™ and Dentsply Sirona’s IRM, which are temporary restorative materials used to restore the endodontic access opening between visits for root canal therapy and prior to placement of a definitive restoration. Cavit, even more so than IRM, is inexpensive, conveniently packaged, easily handled for efficient placement, and easily removed. “Grab the Cavit” was once synonymous with “We’re done. Seat the next patient.” Moving on from materials so ingrained in our workflow can be a challenge, but strong data cannot be argued against.

Coronal leakage, or the recontamination of root canal spaces, is perhaps the most common reason for endodontic failures.¹ Gutta percha alone provides an exceptionally poor seal, and oral and salivary contaminants can reach the apical tissues in as few as 3 days.² Both Cavit and IRM lack the ability to chemically bond to dentin and enamel, allowing for microbial and direct salivary leakage along their margins.³ Although intraorifice barriers can preclude these contaminants from reaching the gutta percha directly, their use is limited in areas where posts are needed or when restorative dentists prefer to bond core materials directly to the chamber floor.

A simpler option is to use a temporary restorative material that chemically bonds to dentin and creates an impenetrable seal for saliva. Resin-modified glass ionomer cement materials such as Centrix® Tempit® Ultra-F and GC America’s Fuji Triage® fulfill the properties of ideally sealing materials while maintaining ease of placement and removal. Their increased cost can be justified in the hours of saved chair time for lost or worn fillings or, worse, root canal retreatments needed when coronal leakage does occur. I prefer a material that does not require trituration, so my preference is for Tempit Ultra-F. That said, certain referring dentists find its esthetic white shade difficult to discern from existing porcelain restorations, so the pink shade of Fuji Triage allows for easy contrast during removal.

Ultimately, endodontic treatment is incomplete until the tooth is definitively restored. As an endodontist, I often treat infections significant enough that multiple visits are warranted, and interappointment coronal leakage defeats the purpose of intracanal disinfection. Additionally, I prefer to have the excellent restorative dentists that I am privileged to work with complete definitive restorative care, and a well-sealed temporary in the form of a resin-modified glass ionomer sets everyone up for success.

References

1. Salehrabi R, Rotstein I. Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment. J Endod. 2010;36(5):790-792. doi:10.1016/j.joen.2010.02.009
2. Swanson K, Madison S. An evaluation of coronal microleakage in endodontically treated teeth. part I. time periods. J Endod. 1987;13(2):56-59. doi:10.1016/S0099-2399(87)80155-3
3. Barthel CR, Strobach A, Briedigkeit H, Göbel UB, Roulet JF. Leakage in roots coronally sealed with different temporary fillings. J Endod. 1999;25(11):731-734. doi:10.1016/S0099-2399(99)80119-8

Al-de-hyde. Where have we seen those syllables before? Definitely in anatomy lab. Probably during high school frog and college fetal pig dissections. Do you see a trend here? The aldehydes in our past were consistently related to dead bodies. What makes us think that placing an aldehyde in a live mouth is a good idea?

The US Department of Labor says this about glutaraldehyde: “Contact with glutaraldehyde liquid and vapor can severely irritate the eyes and at higher concentrations burns the skin. Breathing glutaraldehyde can irritate the nose, throat, and respiratory tract, causing coughing and wheezing, nausea, headaches, drowsiness, nosebleeds, and dizziness.” It also states, “Prolonged exposure can cause a skin allergy and chronic eczema, and afterward, exposure to small amounts produces severe itching and skin rashes. It has been implicated as a possible cause of occupational asthma.”

My initial experience with glutaraldehyde contained a warning: keep it away from the gingiva. For the most part, I did. Then I placed 4 Class V composites and apparently allowed it to penetrate the gingival margins. The results were awful: nasty white burns that took 2 weeks to disappear. Thankfully, my technique has improved, but it is not a reaction you want to see even once!

Gluma and other glutaraldehyde-based desensitizers work very well. Potential toxicity is just 1 of the reasons that I decided on a trial separation with these products. Here are 3 more:

1. There have been a number of investigations, some contradictory, on the carcinogenicity of glutaraldehydes as a family at various concentrations, especially in Western Europe, where glutaraldehyde-based products are produced.
2. Hemaseal & Cide™, a material from Advantage Dental Products, generates similar or better results without glutaraldehyde.
3. There is a huge difference in cost between Gluma and Hemaseal & Cide. Gluma is much more expensive.

Hemaseal & Cide is a 4% chlorhexidine-based tooth desensitizer. The chlorhexidine is blended with HEMA and water to accomplish desensitization without the toxicity and the worry of burning the patient’s mouth, face, or eyes. Chlorhexidine is well known as a product that disrupts gingival inflammation as opposed to being a potential irritant.

I was one of the Catapult Evaluators in 2019 who evaluated Hemaseal & Cide. The evaluation team treated 150 direct restorations with the product. None of the evaluators reported sensitivity when evaluating the outcomes. Additional studies of Hemaseal & Cide have shown it is capable of raising bond strength by 33%, and 1 study demonstrated that it is more resistant to microleakage.

How can Advantage Dental Products provide Hemaseal & Cide for less than half the price of Gluma? I’m really not sure. I do know that my 3 years of using Hemaseal & Cide have shown no uptick in my patient’s postop sensitivity following restoration placement. In fact, composite placement and indirect restoration cementation have shown a degree of comfort I had not seen before. And the material’s unidose applicators have been a blessing during COVID-19 times.

Hemaseal & Cide is a keeper! I don’t miss aldehydes at all.

It has been amazing to see the advancements in technology in the dental industry over the past 30 years with the implementation of computer systems and software. Where once we had dental offices with thousands of charts with barely legible penmanship buried away in file cabinets only to be misplaced, lost, or damaged, we now have massive digital storage capabilities in the office as well as on the cloud to store everything. This allows us to instantly access all our patient records, including clinical records, high-resolution radiographs, 3D scans, digital photographs, digital models, and mock-ups.

Software and the internet have replaced traditional office telephone systems that served only 1 function: phone calls. The ability to implement a software application with a Voice Over Internet Protocol (VoIP) technology at the front desk created hundreds of new opportunities and increased revenue with the need for fewer employees. The system allows for traditional phone calls on the internet, but they are recorded and can be replayed for training purposes and accountability. In addition, it is capable of text messaging and sending bulk emails with important content. It also can send automated messages to remind patients of appointments or to remind new patients to fill out their forms online prior to arrival. Past-due patients can be contacted, reactivated, and reminded, and existing clients can be reminded of upcoming appointments, wished a happy birthday with a custom video, asked to pay a bill instantly via their cell phone, provided a link to leave a review, and so much more. The need for multiple employees to manage a front office is gone. With a VoIP phone system in place, such as the one from Weave, an office can be more productive through automation than ever before. Software systems have simplified the office so much that even new employees can be trained faster than ever with 24/7 online education platforms.

Websites are responsive in design to fit any size device from a digital billboard to a cell phone or tablet. Social media can be used to promote video and content. Platforms such as Zoom and other videoconferencing software have changed virtual learning forever. Traditional dental continuing education can be expensive because of all the travel, hotels, and meals in addition to the course fees. However, with the widely adopted webinar education online, dental health care professionals can save money and time.We have been introducing dentists to unique, unconventional training content and concepts on case acceptance, marketing, time management, didactic and hands-on dental procedures, and more since 2018 via my LEGION online dental training.

It is easier than ever to run a successful dental office with all the technology and automation that are available.

Since I was in dental school almost 40 years ago, endodontic obturation has undergone an evolution. For decades ZOE- and CaOH-based materials were the standard but had some potential clinical problems, such as dissolution apically under some clinical situations and tissue irritation if extruded periapically.

Shortly after my graduation, resin-based sealers were introduced and were a step forward to an obturation material that had fewer issues associated with ZOE- and CaOH-based sealers. Those epoxy-based resin sealers provided lower solubility, low shrinkage, and fewer tissue issues if expressed periapically. But resins are hydrophobic in nature, so the canal and its associated dentinal tubules need to be dry—any moisture at the interface could prevent a seal to the canal walls. Resin sealers transitioned to methacrylate-based sealers, which improved on the properties of the epoxy resins but did not fully eliminate some of the potential issues with resin use in a system that may not allow complete drying of the dentinal tubules at the canal walls. Incomplete drying might prevent a complete seal over the entire canal system and be a potential source of leakage leading to endodontic failure.

Better alternatives were developed that overcame these issues, and the first-generation of mineral trioxide aggregate (MTA) bioceramic sealers was introduced in the 1990s. The bioceramics had been used in orthopedics and demonstrated excellent biocompatibility. Nevertheless, MTA had some disadvantages, including a long setting time, low cohesive strength, and poor handling properties. With the drive toward dental materials for all aspects of treatment, including bases, liners, and restorative materials, an age of bioactivity had blossomed. Progress continued as bioceramic endodontic sealers were developed with improved handling and bioactive properties.

I recently was introduced to the Bio-C Sealer Ion+ from Angelus®, a Brazilian endodontic company with a long track record with MTA, endodontic sealers, and fiber posts. Independent university-based research confirmed Bio-C Sealer Ion+ has high calcium ion release and a reparative wound-healing capability, is noncytotoxic, and provides good cellular adhesion with organic/inorganic tissues, making it an ideal endodontic sealer.

I like that Bio-C Sealer Ion+ is premixed, making it easy to place into the canal with its disposable injection tips. It also sets in the presence of moisture, with less than 240 minutes setting time so any residual moisture in the dentinal tubules will not hamper sealing at the canal wall interface. As the sealer is not affected by temperature, it can be used with warm or cold obturation techniques. Its low film thickness of approximately 16 μm, combined with its good flow properties, permits adaption to intricate secondary canal anatomy. Its excellent radiopacity, thanks to inclusion of zirconium oxide radiopacifier, makes radiographic verification easy without staining the tooth as had been reported with MTA. Low solubility and its eugenol- and resin-free chemistry help ensure a long-term seal and eliminate biocompatibility issues should material be extruded apically.

Reference

Sanz, JL, López-García S, Lozano A, et al. Microstructural composition, ion release, and bioactive potential of new premixed calcium silicate-based endodontic sealers indicated for warm vertical compaction technique. Clin Oral Investig. 2021;25(3):1451-1462. doi:10.1007/s00784-020-03453-8

When I started my practice in 2005, I never would have imagined a patient case where I wouldn’t opt for traditional milling to create a crown, onlay, or veneer. But after the paper mill in my town closed down and the majority of my patients lost both their jobs and their health insurance, I needed to find a more cost-effective way to make restorations so I could pass those savings to my patients without jeopardizing quality.

The solution was 3D printed restorations. For a long time, 3D printing was not widely used for fabrication of crowns or other types of restorations due to a lack of materials capable of providing the desired mechanical properties, accuracy, and fit to tooth preparations or other structures. Formlabs Permanent Crown Resin—a tooth-colored, ceramic-filled resin that enables 3D printing for permanent single crowns, inlays, onlays, and veneers—changed that for me. The cost, quality, and versatility of the resin paired with the Formlabs 3D printer has enabled me to provide my patients with the smiles they want faster than ever.

Cost Savings for Patients

Milling is a reliable restoration technique when you only need to create restorations for a few teeth. But when a case calls for multiple restorations, it can become cost prohibitive. To create restorations for 12 teeth, it would cost $500 to mill a block of resin, whereas it would cost only $53 to create the same restorations with a Formlabs 3D printer and Permanent Crown Resin. Beyond that, a milling machine can cost $50,000 compared with a Form 3 printer that costs less than $5000, making it clear that from a cost standpoint, 3D printing provides more benefits than conventional restoration methods. With an accessible price point and low per-part cost, Permanent Crown Resin enables dental businesses of all sizes to achieve high-quality restorations through 3D printing.

Creating Beautiful Smiles

Permanent Crown Resin provides high-strength, long-term restorations with an accurate and precise fit. The material also offers low water absorption and a smooth finish to decrease the tendency to age, discolor, or accumulate plaque. Available in 4 VITA classical shades to match any tooth color, the resin enables my practice to create crowns, onlays, and veneers that mimic the quality of higher-end production methods.

The switch to digital workflows and 3D printed restorations was the right choice for both my practice and my patients.

As dental professionals we have the opportunity and obligation to explore new technologies and equipment that could improve our practice and methods of treatment. Evaluating these devices requires a critical eye, involving research, demonstrations, training, and more to determine the value and benefit of adopting a new process or device. When the decision is made to move forward, it can sometimes mean leaving previous, commonly used equipment behind. In recent years, I have moved away from using more traditional devices, specifically a scalpel, and opted for less invasive technology such as the Waterlase dental laser from BIOLASE®.

Scratching the Surface: Lasers vs Scalpels

Due to their invasive nature, scalpels can have physiological and psychological effects on patients. With the Waterlase, a cut can be made quickly with a unique level of accuracy. Ultimately, this means the cut is less invasive, which can mean minimized bleeding, less postoperative pain, and faster healing times.

During a procedure when I would typically use a scalpel, I now reach for my Waterlase. The laser allows me to take a less invasive approach that generally leads to less bleeding, swelling, and bruising. This also can mean less pain during and after a procedure, which can increase the patient’s comfort level and keep them coming back. Dental lasers also minimize trauma after dental surgeries, ultimately eliminating postoperative discomfort in most patients. In addition to reducing pain following a procedure, using a laser can lead to faster healing times.

With all this in mind, the benefits reach far beyond the initial procedure. For me, swapping out my scalpel for a more modern approach has continuously proved to be beneficial for the patients who put their trust in me to provide quality oral care.

Should You Make the Switch?

Although more traditional equipment, including the scalpel, has been used for years and proven effective, there are reasons why new technology is created. We must adapt if we want to achieve optimal results for our patients and provide a better experience all around. I recommend that dental professionals, no matter the specialty, consider new technologies and go deeper to determine if it is time to make the switch.

Every day, dentists are inundated with technological advances and the next new thing. Most of the time it’s acceptable to delay incorporating these. But practicing dentistry with an air-driven handpiece is like driving a go-kart in a Formula One race. Air-driven handpieces have been satisfactory, but at some point it becomes our responsibility to incorporate innovation that will improve patient outcomes. European markets, known for advanced dentistry, have reached greater than 90% electric handpiece utilization, but the US market has been slow to make the transition. The electric handpiece is the most important piece of equipment a restorative dental practice can own.

I started my dental training with air-turbine handpieces, but in 2008 I was introduced to electric handpieces. This happened during my clinical training before graduation, in a selective training program in esthetic and biomimetic dentistry. The training included the opportunity to use the most advanced equipment, including an electric handpiece. I quickly realized that electric handpieces were mandatory for the precision and quality of work I wanted to provide.

Advantages of the Electric Handpiece

The electric handpiece is known for its higher torque and power compared with air-turbine handpieces. Whereas an air-turbine loses speed immediately upon contact with tooth structure, the electric motor provides the power and torque to maintain a consistent speed. One of the most important features is the ability to precisely set and program the speed for different clinical steps or procedures. The consistent speed and high torque help me focus more on achieving the desired clinical result and less on controlling the pressure and speed of the handpiece. This in turn allows me to achieve the best results with less time and effort. Electric handpieces help me work smarter, not harder.

Crown Removal

Cutting through zirconia and lithium disilicate crowns has never been easier. The electric handpiece can be used with moderate pressure at its highest speed. which can be in the range of 200,000 rpm to allow optimal cutting efficiency and speed. Vertical brushing strokes allow for visualization and identification of the preparation depth, minimizing inadvertent removal of tooth structure in the process.

Margins and Finishing

After reduction and initial margin placement, finishing and smoothing the margin can be completed effortlessly. The motor speed is turned down to between 10,000 and 20,000 rpm. By using a fine diamond bur with horizontal brush strokes, the margin can be finessed to a smooth continuous finish. The entire preparation can be smoothed in a similar approach.

Caries Removal With FG Burs

Diamond-prepared dentin is preferrable to carbide-prepared dentin for adhesive restorations. An electric handpiece allows use of FG diamond round burs at 10,000 to 15,000 rpm to complete caries removal. Minimal vibration with this approach prevents inadvertent pulp exposure.

Contouring Anterior Restorations

Finishing discs work best with slow speed and high torque. The ideal rotation speed to precisely contour anterior restorations with a finishing bur or disc is between 1500 and 5000 rpm. This speed allows contouring and evening the surface without inadvertently overreducing. This speed is impossible to reproduce with air-turbine handpieces.

The single unit crown is one of the most common and lucrative restorative procedures in a general dental practice. A part of that workflow is the provisional crown. It is critical to providing protection of the prep, allowing the patient to be able to function on the prepared tooth, providing esthetic temporary replacement of the tooth, and maintaining the interproximal and occlusal integrity while the final crown is being fabricated. Still, the workflow needs to be accurate and expedient on the initial appointment.

I learned to make provisionals with a prefabricated partial tray, such as the Premier® Triple Tray®, and a high-durometer vinyl polysiloxane impression material such as Kettenbach’s Silginat® or StatusBlue from DMG to create the temporary crown matrix before I cut the preparation. I still use this technique for most longer span bridges.

But there is the cost of the single-use disposable tray and the impression material—which is still relatively expensive and can be wasteful in the automix cartridge system because it is only a small impression. Then there is the setting time for the vinyl…just more waiting time.

Efficiency not only increases productivity—it also will increase patient comfort and satisfaction.

The Matrix Button is a small plastic disc prior to being warmed and formed to create the temporary crown matrix.

For the single crown I now use the Matrix Button from Advantage Dental Products, Inc. This is a thermoplastic button that when placed in hot water becomes pliable and adaptable to the tooth/arch form.

In 2019, I evaluated these as a member of Catapult Education. Sixteen members of the evaluation team tested the Matrix Button in their practices, and 78 provisional crowns and 5 provisional bridges were placed.

My assistant can place the buttons in a cup of hot water (~160 °F) from the tap or from a microwave (30-60 seconds) while we are waiting for the anesthesia.

Once heated, the Matrix Button will become completely transparent. I remove it from the water, roll it into a tube, and place and adapt with my fingers. I have 20 to 30 seconds to do this.

We have learned to wet the fingertips of the operator’s glove before handling the Matrix Button. If the glove is dry, the material can stick to the glove.

A temporary crown matrix formed using The Matrix Button.

When I am satisfied that I have registered all the key points, we blast the Matrix Button with cold water/air. When the opacity returns, it is ready to lift out. If for any reason I am not satisfied with what I see, I can just reheat the Matrix Button and do it again. This is not possible with the tray/vinyl technique.

My favorite provisional acrylic is Luxatemp from DMG America, but the Catapult evaluation also confirmed that Matrix Buttons can be used with a variety of materials. If the more traditional powder/liquid materials such as Parkell’s Snap™ or Alike™ from GC America are used, the manufacturer recommends a separating medium, also available from the company.

A majority of the Catapult evaluators agreed that adding the Matrix Button to their workflow could save them money.

I will never compromise quality or accuracy in my crown and bridge cases, but I hate paying a “stupid tax.” I can get the same provisional crown with the Matrix Buttons as I can with the tray/vinyl technique, but Matrix Buttons only cost about 75 cents each.

Matrix Buttons have other clinical applications. They are excellent to use for a morning mandibular positioning appliance. I could make a transitional bruxism device (similar to an NTI™) in less than 90 seconds, or a simple, quick, cheap bite registration, even if I use 2 or 3 buttons.

There are no panaceas in restorative dentistry, but Matrix Buttons, which have a minimal learning curve, have become a go-to product in my practice.

Oxygen.

Baseball.

The dental mirror.

Some things are indispensable.

Think for a minute about your dental practice. What’s the 1 instrument on every tray used at every appointment? You probably don’t think about it all that much, it’s just part of your routine. Of course, I’m talking about the standard dental mirror. We use it for examination, treatment, retraction, soft tissue protection, and light redirection.

And the truth is, I haven’t thought about my mirror much over the years. It just does what it’s always done. It’s a metal handle and a reflective surface, simple and effective. But everything else in my office has changed. I’ve adopted digital x-rays, digital photography, intraoral scanning, diode lasers, and cloud computing. My flip phone was tossed long ago in favor of my iPhone. Time marches on, and technology makes the practice of dentistry better for the patient and the doctor.

Recently, I’ve introduced a new technology into my ortho office–SmartMirror. It’s the smartphone update of my old No. 5 mirror. Right out of the box the features are impressive: great ergonomic feel, super-bright true color LED lighting, and a fog-free sapphire mirror surface that’s basically scratchproof.

But the really cool part is inside. There’s an HD micro-camera behind the mirror that sends images wirelessly in real time to a chairside screen or your iPhone. Capturing still images and videos is as simple as tapping the screen, and the built-in microphone allows for voice-to-text dictation. The images are incredible, and I can view up to 10× magnification simply by positioning the autofocusing mirror closer to the tooth surface (as close as 3 mm). No loupes, no microscope. Just SmartMirror.

SmartMirror is my go-to choice for every new patient exam, and it helps me build a trusting relationship from the start. I’m able to show the patient and parent any areas of concern, and we all see the images together on a big, ceiling-mounted screen as I’m examining the dentition. No more sales pitches about the benefits of orthodontics. I don’t sell—I show. And patients can tell the difference.

In the treatment area, my hygienists love SmartMirror for patient education and motivation. We give the patient an iPad so they can see the challenging areas. Tap the screen, capture an image, and send it via AirDrop (or any other method) to the patient’s phone. It takes approximately 10 seconds—no more grabbing the clinic camera, retractors, and a mirror.

During the COVID-19 pandemic, SmartMirror has been especially beneficial. I can quickly capture and send an image to another office to get a chairside consult. It saves the patient a trip and eliminates an extra appointment for both offices.

And these are just a few examples of how we employ SmartMirror in my office. I couldn’t imagine going back to my old No. 5. SmartMirror offers enhanced treatment ability together with incredible patient communication. It’s a game-changing combination.

Staining. Calculus buildup. Altered taste. For dental professionals, 1 word comes to mind when you hear these terms: chlorhexidine. When I chose to follow in my father’s footsteps and pursue dentistry as my career, I envisioned offering high-quality esthetic dentistry and alleviating my patient’s fears. The downfalls of chlorhexidine were something I didn’t want patients to associate with my practice, so I reluctantly used the rinse sparingly and with caution.

Chlorhexidine as a dental rinse was introduced to the dental industry in 1954 to treat gingivitis. The broad spectrum biocide boasted great bacteria killing capabilities—that is, if your patient could adhere to the intricate instructions and frustrating adverse effects. Patients are required to wait 30 minutes to use it after using other dental products (including toothpaste) and must avoid drinking, eating, and smoking for at least 1 hour after using it. And now we’ve discovered that saliva and blood can inactivate chlorhexidine. It also should be used for a maximum of 2 weeks. Though chlorhexidine’s only indicated use is gingivitis, for the past 67 years many dental professionals have used it off label to treat caries. Yet study after study that I found showed shocking findings, such as damage to fibroblasts, cytotoxic effects, overall disruption to the healing process, and an increasing number of anaphylactic cases. I knew we had to find a safer, more effective alternative for our patients.

I began searching for an alternative in 2019 and through web research stumbled upon OraCare. OraCare’s active ingredient, activated chlorine dioxide, kills the same bacteria as chlorhexidine but with only 44 ppm as compared with the 1200 ppm chlorhexidine requires to achieve results. Because chlorine dioxide is a gas, it dissipates through the tissues quickly and without lingering adverse effects (including no staining or calculus buildup). Activated chlorine dioxide also effectively removes biofilm, neutralizes volatile sulfur compounds, and kills fungi and viruses.

We scheduled a webinar to educate the team and began using the rinse. As patients came in for their chlorhexidine, we began transitioning them to OraCare. The feedback was tremendous, and the results spoke for themselves.

Today, OraCare is a staple at our practice, Calera Dental Center in Alabama. In fact, we send it home with approximately 80 patients a month. Not only do we love the rinse as a chlorhexidine replacement, but also we find it helps patients with a range of other issues. We recommend it for biofilm removal, bad breath, dry mouth, canker sores, cancer care, and more. The best part about OraCare is not only do my family and I use it, but I know that my team is recommending a rinse that aligns with the standard of care we set out to provide our patients.

I’m dean of the College of Dental Medicine, opening in 2022, at Lincoln Memorial University in Knoxville, Tenn. I was a practicing dentist for almost 30 years and have been in academia since 2014. I believe the oral cavity is the intersection between medicine and dentistry. It is a window into the general health of the patient. From the start of my career through today, dental caries remains the most prevalent chronic disease in both children and adults, even though it is largely preventable. Traditional professional products used for high caries rates include fluoride trays and varnishes.

Of course, fluoride is very important to maintain oral health. But today there is an adjunct therapy that will vastly improve oral health by balancing the microbiome. Due to more than 30 years of peer-reviewed research on the oral microbiome, oral-care probiotics are now available.

How do oral-care probiotics work? ProBioraPro Health® lozenges contain a proprietary combination of strains of 3 beneficial bacteria—Streptococcus oralis KJ3, Streptococcus uberis KJ2, and Streptococcus rattus JH145—that support gum and tooth health. The positive bacteria are activated by saliva and released to colonize on tooth surfaces and along the gum lines, in essence crowding out the pathogenic bacteria. We all know it’s the pathogenic bacteria that lead to caries, gingivitis, and gum disease, and often to chronic diseases such as diabetes, Alzheimer disease, and cardiovascular disease, among others. ProBioraPro’s products are easy for patients to use at home. Dental offices can dispense the product or patients can purchase it online.

Oral-care probiotics are a hugely important adjunct, really a game changer, when it comes to daily oral hygiene routines. Unlike fluoride trays and varnishes, which are effective for a relatively short amount of time, taking daily oral-care probiotics provides positive benefits for as long as they are in use. In as little as 2 weeks, the pathogenic bacterial load is significantly lessened. As their use becomes more widespread, individuals will discover enhanced oral health, and potentially their overall health will improve. After all, a healthy body starts with a healthy mouth.

On a recent trip to the Smithsonian Institution in Washington, DC, I viewed extraction forceps from the 19th century. Many of the instruments were recognizable. It struck me that within our profession some tools of the trade have been around for decades without significant change. Throughout my 30-year career as an oral surgeon, I have treated many patients with xerostomia. Like the forceps in the museum case, treatment modalities for xerostomia have changed very little during my time in practice.

Until very recently, I’ve recommended a familiar array of coping strategies, over-the-counter (OTC) products, and prescription medications to help my patients deal with conditions that range from annoying and uncomfortable to absolutely debilitating. My first-tier recommendation traditionally has been to improve oral tissue hydration by sucking on ice chips or frequently sipping water. My next-level intervention is directing patients to OTC sprays, solutions, and lozenges that offer temporary relief to a segment of the approximately 15 million Americans who have some degree of xerostomia. Unfortunately, salivary substitutes and water are quickly swallowed from the oral cavity, leading to the return of annoying or painful symptoms. The next level in my protocol is to consider pharmacological treatments. Sialagogues such as Salagen® and Evoxac® are used with varying degrees of success. These cholinergic agonists can be beneficial but also are accompanied by a significant list of adverse reactions. Additionally, for these prescriptions to offer relief, the patient must have some percentage of residual and functional glandular tissue. This is not always the case, particularly for those patients where xerostomia is the result of autoimmune disease or cancer treatment. Until recently, I have provided this same array of treatments to my patients with xerostomia with unpredictable and variable levels of patient satisfaction.

Earlier this year, an innovative device for treating those with moderate to severe xerostomia was introduced. I have found Voutia™ to be effective for patients with xerostomia who are dissatisfied with OTC and prescription options as well as the associated long-term costs. The Voutia system consists of a portable, FDA-cleared pump and fluid reservoir that can be used any time on demand. The pump is slightly larger than a smart phone. The system delivers water into the oral cavity at a programable physiologic rate through a nearly invisible microtube. Except for the most vigorous sports activities, the hands-free design, portability, and discreet tubing allow my patients to comfortably pursue hobbies and activities such as gardening, bicycle riding, or even public speaking.

To be clear, there is still a place in my protocol for more frequent oral hydration, OTC products, and medications. But the Voutia technology provides a predictable option—one that didn’t exist until very recently—for the moderate to severe end of the patient continuum. I have found Voutia to be a terrific adjunct for borderline cases and an outright game changer for the patient with severe xerostomia who has tried more traditional treatments to no avail. Patients have reported speech improvement, the need for fewer NSAIDs due to chronic sore throat pain, and a return to more normal sleep patterns after using the device. For patients with xerostomia who are not satisfied with current treatments, Voutia may provide an answer.

More than 50 million individuals in the United States and 1 billion individuals globally experience some form of sleep disorder and obstructive sleep apnea (OSA). Most are not aware of Vivos Therapeutic’s all-natural, nonsurgical, and pain-free approach to help combat this silent killer.

As a dentist, I began my journey in treating OSA with snore appliances and mandibular advancement devices, which helped many of my patients but did not address the root cause of their problem. Some of my patients also had underlying effects of OSA that can be seen in myriad illnesses, including high blood pressure, heart failure, stroke, coronary artery disease, and other chronic conditions that affect quality and length of life.

I was so focused on how to fix OSA and what to use to fix it that I skipped the opportunity to learn about why it was an issue. Approximately 15 years ago I began asking why. Why do teeth crack and break? Why do some patients have temporomandibular joint dysfunction (TMJD) issues and not others? Why do some patients with temporomandibular disorders (TMD) respond and resolve while others still struggle? By asking “why” enough times, I learned that airway and sleep issues were often underlying conditions in my patients who were struggling with dental issues and joint problems. And, in fact, they were the cause. 

The airway anatomy has an enormous impact on a person’s ability to breathe properly and consequently sleep effectively. Recognizing that the size, shape, and position of the maxilla, mandible, tongue, and related soft tissues make up the entire anterior and lateral aspect of the airway was a profound discovery. I could pull or advance the mandible forward with my appliances to create more space and a better airway in 1 dimension. But what if there were a way to grow and develop the maxilla laterally and anteriorly, increase the intraoral tongue space with tooth movement, and position the mandible more favorably forward to enhance the complete anatomy of the airway?

I have discovered as I integrated the Vivos System into my practice that I can help patients improve their oral and airway anatomy and improve their airway function while breathing and sleeping. Offering an all-natural, nonsurgical, and pain-free approach, the system combines the use of oral appliance technology with a multidisciplinary protocol that focuses on all anatomical and functional issues.

The Vivos Mandibular Repositioning Nighttime Appliance design holds the mandible forward with the proper mechanics and, with enough wear time and activation of the upper and lower appliances, it can create more maxillary and intraoral tongue space.

I no longer treat symptoms of OSA or sleep disorders with traditional supportive appliances or other modalities. Instead, I fully diagnose my patient’s condition, determine a therapeutic treatment plan to correct orofacial deficiencies, and prescribe a custom oral appliance to correct them. As a dentist, I believe the Vivos technology is significantly better than anything else for treating sleep apnea.

Determining an accurate tooth shade match in the esthetic zone is one of the most critically important procedures in restorative dentistry and remains one of the greatest challenges facing the clinical team and the ceramist. Using contemporary shade guides is a well-established and cost-effective method for determining tooth shade values. However, this endeavor remains largely subjective due to factors such as ambient light in the environment, clinical experience, color perception, and eye fatigue.

The intuitive and easy-to-use Optishade connects to an iPhone and provides instant and unbiased shade data.

The most prevalent approach to optimizing tooth shade selection and subsequent fabrication of a definitive restoration with an appropriate shade match relies heavily on the clinician’s competence with a digital single-lens reflex camera (DSLR) combined with the ceramist’s skill with a porcelain brush. In our high-end practice, we have relied exclusively on various analog shade guides and the translation of how the eye perceived these shade guides with the use of intraoral DSLR photography, but this protocol has numerous shortcomings and pitfalls. The average dentist requires approximately 15 minutes to accurately obtain the proper shade for a single central restoration. With this in mind, our dilemma is further exacerbated by the well-documented phenomenon of dehydration that human teeth undergo within the first 1 to 2 minutes of this process, which negatively affects the final tooth shade assessment.

The Optishade provides objective, side-by-side comparisons and shade analysis of patients' teeth to aid in communication between clinicians and lab technicians.

Although it is inevitable that occasional miscommunication or misinterpretation of critical information between the practitioner and the laboratory technician will occur, the objective is to reduce these errors as much as possible. For many cosmetic dentists, it is not an uncommon practice to need 3 or more appointments to obtain a seamless shade match of a single anterior restoration, and in a fast-paced dental clinic the impact of these errors translates to lost time, revenue, and reputation.

The Optishade is small, compact, and comes equipped with a durable carrying case for safe transportation between locations.

The clinical and laboratory demands of delivering more predictable definitive restorations have given rise to the recent development of the iPhone-compatible OptiShade app from StyleItaliano and its colorimeter, which is available from Smile Line USA. This novel, easy-to-use, objective shade-matching colorimeter is a major advance in the collaborative workflows between the dentist and the ceramist. Tooth color measurements made with OptiShade are precise and repeatable. They eliminate the guesswork and years of experience often required to interpret traditional shade guides. From the laboratory standpoint, the OptiShade compares the tooth shade data obtained by the practitioner with commercially available shade guide databases. It then imports this information into a software application that provides a detailed ceramic recipe necessary to create the perfect shade match. This methodology can eliminate much of the trial and error or frustration typically associated with difficult prosthetic treatments, such as the restoration of a single central incisor.

The clinical importance of accurate and unbiased shade selection in esthetic dentistry cannot be overemphasized. Technology-based tools such as the OptiShade hold great promise for the future and have rapidly kickstarted the evolution of the dental profession toward a more objective clinical standard.

In more than 40 years of practice and decades of teaching adhesive dentistry for esthetic posterior restorations, I have tried or used every style, shape, and series of standard and designer instruments. The egg burnisher, the ball burnisher, the P-1, the 21B Acorn, the spoon shape, and many others. That was the problem: too many instruments, most of them designed for amalgam. We don’t condense composite the same way we did amalgam, we don’t polish composites the same way we did amalgam. With the advent of the newer “no universal top layer” bulk fill composites, I can’t justify wasting time passing multiple instruments while layering in the posterior region.

Figure 1 - The Roetzer Posterior Packer and Sculptor (PPS) instrument features 2 small packer tips at one end.

So what if we had the tooth design the instrument?

I finally have a 4-in-1 instrument that packs the proximal box, pushes the composite into the channel, and contours the precured composite into a natural anatomy.

Figure 2 - The Roetzer Posterior Packer and Sculptor (PPS) instrument features dual burnishers.

The Roetzer Posterior Packer and Sculptor (PPS) instrument and the complementary Occlusinator PRO finishing and polishing bur system—both available from Strauss Diamond—were developed to create superior anatomical features in posterior composite restorations in less time, with fewer steps, and with fewer instruments to scrub, sterilize, and rotate.

I can shape occlusal contours in composite before curing to reduce postcure cutting. For stronger restorations, I waste less composite. And prices range from $20 to $30 per gram, a big help.

At 1 end of the PPS instrument are 2 small packers; a 0.8-mm tip for fissurotomies and “slot-box-only” preparations, and a 1.5-mm tip for larger proximal boxes (Figure 1)

At the other end are the 2 burnishers (Figure 2): a large ball that can be used to push the composite into the channel and an acorn burnisher to quickly sculpt planar anatomy (Figure 3). It is reminiscent of the old 21B Acorn burnisher we all used in dental school.

Acorn burnishers have a 97-degree angulation, which reflects the cuspal angles in posterior teeth. I had to keep asking myself, “If the dimensions are universal, why am I complicating this work?”

The stainless steel instrument has a 3/8-inch diameter handle for a positive firm grip in my hand and weighs only 1 ounce.

Figure 3 - The burnishing ends of the Roetzer Posterior Packer and Sculptor (PPS) instrument can be used to sculpt restoration anatomy.

Once I have cured the composite, I use the new Occlusinator PRO burs to finish and polish the restoration. The 3 Acorn burs have the same 97-degree angulation and a diamond-free safe zone to prevent overcarving.

Overall, I can recommend the whole system, but one would do well just by having the PPS instrument in every setup tray. And, by the way, I’m not just the clinician and teacher, I’m also the inventor.

It astounds me how vulnerable our practices were in the past (before the cloud-based systems we know today existed) due to limited software capabilities.

Ever have a big thunderstorm in your neck of the woods? A blizzard? Hello, power surges!

What if a fire in the building next door spreads to your office? Or what if your office sustains water damage from firefighters battling the blaze? Our practices were completely susceptible to total data loss with no possibility of recovery.

Also in the old days, we had just 1 office. All our patient imaging was saved to the system at our practice because where else would we do a diagnosis?

With the COVID-19 pandemic making remote work even more popular and accessible, and with the rise in dentists practicing out of multiple sites, this is no longer the case for most practices.

In 2000, 74% of all dental practices were solo practices, and now it’s 51%. We’re at a tipping point where more dentists than ever are working out of multiple locations, which pushes the industry to come up with new solutions.

Cloud imaging software is by far the best solution to the problems today’s dentists face, such as when patients want answers right away.

For example, Mrs Jones calls with a question and you’re out of state for a conference. My practice uses SOTA Cloud, so I can easily pull up her x-rays on my iPhone and give a quick consultation. That’s a practice builder because you’re impressing Mrs Jones with what you’re seeing remotely. It’s enhancing your reputation as a high-tech, high-touch doctor.

You want to be that doctor? Get cloud imaging software.

Not only does cloud-based dental imaging software provide patients with a faster diagnosis, it also protects your practice from data hacking. Security is a massive issue. Just ask Colonial Pipeline about that. Unfortunately, it is something we all have to consider.

If hackers can penetrate the on-site capabilities of enormous companies, they can get to small practices like yours and mine.

More than ever, we dentists need to step up our software to protect our patient information. If you have the backing of some of the largest, most secure companies on the planet with cloud-based imaging systems, you’re good to go. You have security, you have scalability, you have remoteness, all of which are highly important.

Make your life simpler and everything will go smoother.