Monthly Archives: January 2018

Heroic Dentistry: Crowns for a Cancer Survivor

By Jack D Griffin, DMD

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.

Patients undergoing cancer treatment face a variety of oral health challenges, including xerostomia. Without sufficient saliva to neutralize acids and support the natural remineralization process, patients suffering from dry mouth can be more susceptible to the acids that cause tooth decay.

Such was the case of a 78-year-old female cancer survivor who presented at my office with rampant root surface decay (Figure 1). She had undergone radiation and several rounds of chemotherapy over a five year period and had been cancer-free for over a year by the time of our appointment.

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The chances of recurrent decay with traditional bonding and composites are high, so my first step was to thoroughly remove caries with the help of caries indicator (Figure 2). After the decay was removed, I followed a total etch protocol and built up the crown preparations using ACTIVA BioACTIVE-RESTORATIVE (Figure 3). I chose ACTIVA because of its strength, bioactive capabilities, and aesthetics.

Figure 1: Shows difficult restorative case with rampant, post radiation, root surface decay

Figure 2: Shows thorough caries removal with the help of caries indicator.

Figure 3: After a total etch protocol the crown preparations were built up using ACTIVA BioACTIVE-RESTORATIVE.

The preparations for the individual indirect restorations were subgingival in most places. Choosing the right materials, in this case a hydrophilic and biocompatible cement, would be important for long-term success. ACTIVA BioACTIVE-CEMENT is not only moisture-friendly, and biocompatible, but also strong, aesthetic, self-adhesive, and dual-cure. This bioactive luting material releases and recharges fluoride, phosphate, and calcium, and participates in an ionic exchange that promotes an environment of tissue health.

Figure 4: Shows preparations for individual indirect restorations. Most of these preparations are sub-gingival.

Seven monolithic zirconia restorations were made, tried in, and cemented at the same time with ACTIVA BioACTIVE-CEMENT (Figures 5-7). The ACTIVA BioACTIVE-CEMENT was easy to clean up. Figure 8 shows the final restoration.

Figure 5: Monolithic zirconia restorations were made, tried in, and cemented with ACTIVA BioACTIVE-CEMENT.

Figure 6: ACTIVA BioACTIVE-CEMENT is dispensed into the crown.

Figure 7: All restorations were cemented at the same time and the cement cleaned up easily.

Figure 8: Shows final restoration. I have found that thorough decay removal with bioactive core buildups and cement results in excellent tissue tolerance and long-term prognosis.

New bioactive, self-adhesive cements such as ACTIVA BioACTIVE offer a promising alternative to traditional resin cements. I have found that thorough decay removal followed by core build-up and cementation using bioactive materials results in excellent tissue health and long-term prognosis.  With comparable strength, aesthetics, and durability to traditional dual cure resin cements, ACTIVA has the important benefit of ionic release that may aid in tooth repair. All of this while being very easy to clean up. It may be time to rethink traditional, dual cure, self-adhesive cementation for better patient care.

About Dr. Jack D Griffin
Dr. Jack D Griffin is one of the most honored and awarded dentists in the country. Jack is one of a hand-full of dentists awarded by his peers Diplomat status with the American Board of Aesthetic Dentistry (ABAD), accreditation with the American Academy of Cosmetic Dentistry (AACD), and Mastership in the Academy of General Dentistry (AGD). Jack graduated dental school from Southern Illinois University, where he received student dentistry awards and then went on to complete a general dentistry residency at the University of Louisville in Kentucky, with an emphasis in advanced dental care in restorative dentistry, emergency care, implants, oral surgery, and special patient care. Dr. Griffin began his dental practice in Eureka in 1988.

The Social Dentist Tip #2: Tell a Story with Compelling Content

Dr. Ryan McCall grew his Indiana-based dental practice by engaging new and existing patients through Facebook, Instagram, Snapchat and Twitter. In this series, The Social Dentist, Dr. McCall offers tips on how to market your dental practice using social media.

Tell a story
Far too many dental practices look the same as their competition. In order to stand out, you have to tell a compelling story. Most people want to hear from a human being, not a faceless corporate entity, so we tell stories that reflect our unique personalities and backgrounds. This approach leads to more likes and shares across social media platforms. 

Some of my best stories are personal updates, like a picture of me with my 7-year-old son at our first Colts game.  He is wearing an Adam Vinatieri jersey (first ballot, Hall of fame, he will thank me later), and patients often mention it. Family is a central part of my story, just as it is at Pulpdent. If you haven’t read their story yet, then do yourself a favor and check it out (there’s even a dancing dentist).

I enjoy sharing my personal interests and hobbies with my patients. I’m a sneaker-head, so I take pictures of my vintage shoes as well as old Jordans that patients wear into the office.  Knowing the difference between the Jordan 3s and the Jordan 12s has helped me develop relationships with patients who share the same passion, leading to increased business and, in some cases, gifts of shoes!

Content is King
Good content attracts new patients. Keep your content current, which means using the right format. Ten years ago pictures, I posted photos to bring in new patients, but now video is my favorite. Big companies are already “video pivoting” because it is much more effective than just photos. Facebook and Instagram both allow you to share live video online. You don’t need an expensive camera with a fancy lens – an iPhone will work just fine. There are some great apps like Canva and Boomerang for easy video editing.

Where do I get my content?  I document every case. After 10 years, I have plenty of relevant content. You can share your cases with industry websites, publications and manufacturers for increased exposure. If you are using ACTIVA BioACTIVE, then take pictures of your work and send them to Pulpdent to post on their website and social media sites.

More Articles by The Social Dentist

Dr. Ryan McCall

About Dr. Ryan McCall
Dr. Ryan D. McCall was raised in Illinois. He received his BS in Biology and Chemistry from Indiana University and dental degree from the University of Illinois School of Dentistry. He maintains private practices in Indianapolis and Lebanon, Indiana.

Sealants That Stick: Embrace WetBond Pit & Fissure Sealant

By Amber Auger, RDH, MPH

Our preventive role as dental hygienists is not always easy, especially when it comes to pediatrics. Achieving compliance in parents who continually justify their children’s poor oral hygiene and tooth decay by saying “they have my weak teeth” can test any dental hygienist’s patience. The truth is, we have the ability to prevent tooth decay, and preventive sealants are one of the most effective methods.

The average family with two kids involved in sports has a schedule that would make most socialites envious. An active lifestyle can get in the way of scheduling regular visits to the dentist. A sealant that can be placed in one quick visit is crucial for prevention and patient compliance.

As a new graduate, I joined a pediatric office that was extremely motivated to prevent decay as well as optimize the business production in the hygiene chair. Due to the goals of the office, I was asked to place sealants on most patients the day they were diagnosed with the need. A 30-minute preventive appointment often meant four sealants would be placed in addition to the prophy, oral hygiene education, and fluoride treatment. The child would lift a curious tongue at the last second, and I would be forced to start the process over. Continually running 10 to 15 minutes behind schedule during my first few weeks on the job, I felt defeated. Knowing the importance of placing a sealant with sound margins for long-term durability and protection, I knew I couldn’t let my tight schedule compromise the sealants. After investigating different sealant products, I found one that I loved, Embrace WetBond pit and fissure sealant.

Embrace WetBond is a unique resin-based, moisture-tolerant sealant material.1 The sealant has multifunctional methacrylate monomers that are activated by moisture.2 This technology enables clinicians to effectively place sealants even when there is slight moisture on the tooth, which is especially helpful when treating anxious, orally defensive patients. Embrace WetBond enables clinicians to place better retained sealants with smooth, undetectable margins, and increased fluoride release.1

A longitudinal study conducted by Howard E. Strassler, DMD, and Joseph P. O’Donnell, DMD, MS, reported on the durability of Embrace WetBond pit and fissure sealant after four to six years of initial placement. The study results demonstrated that Embrace WetBond had more than double the retention rate of the leading competitor.2 Embrace sealant is an ionic resin that is rich with phosphates and forms a strong resin-hydroxyapatite bond that seals against micoleakage.3

Choosing products that aid in decreasing the risk of tooth decay is a vital part of every dental clinician’s role. Embrace Wetbond sealant allows clinicians to place high quality sealants with longevity, even with difficult patients on tight schedules.

References
1. Hoffman I. A moisture tolerant, resin based pit and fissure sealant. Dental Tribune. 2009(Dec):17A-18A.
2. Strassler HE, O’Donnell JP. A unique moisture-tolerant, resin based pit-and-fissure sealant: Clinical technique and research results. Inside Dent. 2008;4(9):2-
3. Products – Embrace WetBond Overview – Product Review. Pulpdent website. https://www.pulpdent.com/shop/category/embrace-wetbond-overview. Accessed October 30, 2017.

This article first appeared in RDH eVillage.

Amber Auger RDH

About Amber Auger, RDH, MPH
Amber Auger, RDH, MPH, is a hygienist with experience in multiple clinical settings, including facilities abroad. Amber obtained a master’s degree in public health from the University of New England and a bachelor’s in dental hygiene from the University of New Haven. She holds a part-time position at an elite dental office in Boston, and is chief of clinical technology for Jameson Management. Amber Auger is a key opinion leader for several dental companies, speaker and published author, and can be contacted at amberaugerrdh.com.