July 3, 2018
by Howard S. Glazer, DDS, FAGD
There is no doubt that the world of dental materials and products changes almost as fast as the wind changes direction. Presently, the focus on products seems to be on intraoral scanners, in-office milling and 3D printing. But what about materials and products for everyday “bread and butter” dentistry? Materials and equipment that are faster, easier, and better for the doctor and the patient, who is the ultimate end-user, are the focus. Many of these products did not exist five years ago, and many of these will be replaced in the next five years. The world of materials changes rapidly. Towards that end, this article is divided into sections: adhesives, restoratives, photocuring lights and instruments. But first, a subject that every practitioner should provide for their patients: an oral cancer examination.
The most devastating and destructive of all oral diseases is something that dentists need to address daily when examining patients. No dental examination is complete without an oral cancer prevention examination. Prevention is not really accurate because prevent oral cancer is not preventable by the dentist. However, early detection of dysplastic lesions can intercept the disease progress before it penetrates the basement cell layer and becomes a more critical problem. Devices such as the Velscope (LED Dental), or the DOE system (Dentlight) (Fig. 1), or the BioScreen Oral Exam Light (AdDent) (Fig. 2) are all useful in preventing this terrible disease from disfiguring or potentially threatening patients’ lives. As with all cancers, early detection and treatment are the keys to survival.
DOE System (Dentlight).
BioScreen Oral Exam Light (AdDent).
As a profession, dentistry has always been on the forefront of preventing disease and the destruction of natural tooth structure. In recent years, the focus has changed from minimally-invasive dentistry to bioactive dentistry. In fact, they go hand-in-hand. Dentists have routinely treated patients with bioactive materials – fluoride-releasing glass ionomers and calcium-based cavity liners. Today, there are materials that release those two ions, but now have added phosphate ions into the mix. Activa Base/Liner and Restorative (Pulpdent) materials replace lost phosphate and calcium ions, along with fluoride ion release. This is more restoring a tooth, rather than just repairing a tooth. Certain products minimize the advance of decay and prevent further destruction of tooth structure: Advantage Arrest Silver Diamine Fluoride (Oral Science) (Fig. 3), or Riva Star (SDI Limited) arrest the decay process at its earliest onset. When patients report sensitivity, or exhibit more root structure as they mature, Sylc (NovaMin) (Fig. 4), treats and protects those teeth and reduces patient discomfort from sensitivity.
Silver Diamine Fluoride (Oral Science).
Often, we do not have the opportunity to treat decay before it has progressed to an advanced stage. Fortunately, Theracal (Bisco Dental Products) and Biodentine (Septodont) (Fig. 5), allow treatment of decay that is indirectly or directly compromising the pulp. These products often allow the tooth to remain vital and functional for quite an extended period of time.
The bioactivity concept is seen in cements for crowns, bridges, inlays/onlays and endodontic posts. Theracem (Bisco) and Ceramir (Doxa) (Fig. 6) have calcium ions in their formulation that help promote hydroxyl apatite formation to insure a strong and long-term healthy bond to the tooth.
Composite resins have come a long way since the days of silicates and Adaptic. Today’s composites are durable and highly aesthetic. New composites that have been “tweaked” to offer features that makes them slightly more competitive than existing brands are introduced. Many patients still ask for a “porcelain filling” when referring to composite restorations. Admira Fusion (VOCO) is a Nano-ORMOCER that offers natural-looking restorations. ORMOCER stands for Organically Modified Ceramic and provides us with a ceramic-like restoration offering both natural-looking opacity and translucency, and long-term wear resistance, with low shrinkage stress (Figs. 7 & 8).
Evanesce (Clinical Research Dental) offers easy application that vanishes into the natural dentition and is highly polishable. Whether with a single shade or layering several shades, Evanesce can provide beautiful life-like anterior or posterior restorations.
Shade selection has been simplified with aura eASY (SDI) (Fig. 9) that has combined or bracketed shades to make it simple to create aesthetic restorations. For example, aura eASY combines A1/B1 to create ae1; A2/B2 for ae2; A3/B3 for ae3; and A3.5/B4 for ae4. This highly aesthetic product also addresses the issue of shrinkage stress. Beautifil II LS (Shofu) (Fig. 10) also satisfies dentists’ need for low shrinkage composites. An additional advantage to Beautifil II LS is its proprietary GIOMER composition. Shofu’s GIOMER composites not only offer long term wear resistance but the ability to release and re-charge fluoride ions. Beautifil II Pink (Shofu) provides cervical restorations that are more natural looking, since they blend well with the patient’s gingival coloration. This is a valuable product with an ageing population with increased gingival recession. It should also be considered for patients with a high smile line.
Placing both anterior and posterior composite restorations has become easier than ever before with the introduction of the Optrasculpt & Optrasculpt Pad System Kit (Ivoclar) (Fig. 11). This kit features an anterior and posterior instrument with disposable tips that place and sculpt composites without the composite resin sticking to the instrument. The shapes in the kit include a gray handle instrument used with the 4 mm diameter discs for anterior restorations, along with a black handle instrument that can be used with the ball-tip, wedge, or sculpting point for posterior restorations. Using these instruments makes composite placement fast and easy and leaves the restoration 95% finished and polished.
aura eASY (SDI).
Beautifil II (Shofu).
Optrasculpt (Ivoclar Vivadent).
Photocuring Lights & Adhesives
All composite resins require an adhesive resin and a photocuring light. There are excellent products available. Seventh generation products: Beautibond (Shofu) (Fig. 12), iBond SE (Kulzer), PEAK SE & PEAK LC (Ultradent) and GO (SDI) (Fig. 13), as well as the universal bonding agents such as Futurabond U (VOCO) and All Bond Universal (Bisco), Adhese (Ivoclar), and PEAK Universal (Ultradent) are very useful.
With curing lights, it is critical that the power output, measured as mW/cm², is above 1000 and that the light can proved a decent amount of direct collimation of the light beam in order to reach the depth of the gingival floor of the restoration. Two lights that meet these criteria are the Fusion 5 (Dentlight) (Fig. 14) and the Valo Grand (Ultradent) (Fig. 15).
Fusion 5 (Dentlight).
Valo Grand (Ultradent).
Dentistry and the materials have come a long way from the days of the foot engine and mortar-and-pestle mixing of alloy. Many of the products above will be replaced with better ones in the next several years; while this can be frustrating, it is also beneficial to the practitioner, and more importantly to the patient. OH
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About the Author
Dr. Glazer, international author and lecturer, is a Fellow and Past President of the Academy of General Dentistry, and former Assistant Clinical Professor in Dentistry at the Albert Einstein College of Medicine. He is a Fellow of the American and International Colleges of Dentists and a Diplomate of the American Board of Aesthetic Dentistry. Additionally, Dr. Glazer is a Fellow of the American Academy of Forensic Sciences, and the Deputy Chief Forensic Dental Consultant to the Office of Chief Medical Examiner, City of New York. He continues to be named as a “Leading Clinician in Continuing Education” by Dentistry Today, and one of the Top Dentists in New Jersey by New Jersey Monthly Magazine. Dr. Glazer writes the popular “I Have It..You Need It!” bi-monthly column for Dental Economics magazine.