Monthly Archives: November 2019

Direct from the Operatory: Bioactive Cementation

In the following case Dr. Todd Snyder shows how he replaced crowns on teeth #8 and #9 using ACTIVA BioACTIVE-CEMENT.

Pre Op Smile
Pre Op Retracted View
Prep Shade Photo
Final Preparations
HeatWave Impression Tray (Clinicians Choice) with PVS Impression Material
Bite Registration (DMG LuxaBite)
Retracted View of Provisionals after using Bead Line Technique
Provisional Restorations (Luxatemp Ultra)
Applying Activa Cement to the Crown
Retracted View of #8 & #9 after cementation with Activa Bioactive Cement, prior to removal of excess cement.
Retracted view after cementing #8 & #9 and bonding on the veneers #6, 7, 10, 11 with Bisco All Bond Universal Adhesive and Choice 2 Resin Cement.
Cemented Crowns on #8 & #9 (Activa)
Post Op Smile showing new Crowns and Veneers
Retracted View of New Restorations one week later

About Dr. Todd Snyder

Dr. Todd Snyder received his doctorate from the UCLA School of Dentistry and trained at the F.A.C.E. institute. He is an Accredited Fellow of the American Academy of Cosmetic Dentistry, a Member of the American Society for Dental Aesthetics and a member of Catapult Education. Dr. Snyder created and co-direct at UCLA the first two-year graduate program in Aesthetic and Cosmetic Restorative Dentistry. He lectures internationally and has authored numerous articles in publications worldwide. Dr Snyder is a consultant for numerous companies and has his own online training program known as Legion Pride. Dr Snyder also owns two software companies, is a professional race car driver and entrepreneur.

Direct From the Operatory: ACTIVA BioACTIVE-CEMENT for a 93-Year-Old Patient

By Dr. Susan McMahon

Older patients are at increased risk for root caries because of  gingival recession that exposes root surfaces and  increased use of medications that produce xerostomia. Age related visual impairment and decreased dexterity also can lead to higher caries rates and a decreased ability to adequately maintain good oral hygiene. This makes the margins of restorations particularly susceptible to recurrent decay. Choosing a cement that will not only retain the restoration but also help stimulate remineralization is extremely beneficial for these patients.

ACTIVA BioACTIVE-CEMENT helps stimulate apatite formation, supporting the natural remineralization process and helping seal the margin between the tooth and the restoration. ACTIVA helps to prevent microleakage, maintain the integrity of a sealed margin, and keep the restoration, tooth and surrounding tissues healthy.  ACTIVA BioACTIVE-CEMENT is a combination of bioactive resin, rubberized resin and ionomer glass filler.  It is dual cure, moisture tolerant, and indicated for  all indirect restorations except veneers.  ACTIVA is very easy to use, with no additional etching or adhesive steps, and clean-up is simple and quick.

This 93-year-old female patient had mobility in her upper central and lateral incisors. A four-unit splinted HT Zirconia restoration was indicated for functionality and to increase the likelihood of keeping these teeth for the duration of the patient’s life.   Previous PFM crowns were removed and the central and lateral incisors were prepared for a four-unit splinted zirconia restoration.

93-year-old patient with mobile central and lateral incisors with previously placed PFMs on the centrals.

The patient had +1 mobility on the central and lateral incisors (Figure 1). After removal of the old crowns, the visible areas of demineralization on the central incisors and dark staining on the preps were noted (Figure 2). New splinted crowns would increase a favorable prognosis for these teeth.

PFMs were removed and laterals were prepped for 4-unit splinted restoration. Note the demineralization and dark staining on central preps.

Because of the oral health challenges facing geriatric patients (gingival recession, xerostomia, and home care issues), the margins of this new restoration have an increased susceptibility to recurrent decay.  I chose ACTIVA BioACTIVE-CEMENT because of its bioactive properties, which help support the natural remineralization process and seal the margins.

Restoration seated with ACTIVA BioACTIVE-CEMENT.

At the insert appointment, the provisional restoration was removed, the preps were cleaned, and the restoration was tried in. After assuring the fit of the restoration, it was cleaned with Ivoclean, loaded with ACTIVA BioACTIVE-CEMENT, and  seated (Figure 3). The restoration was initially flash cured  to set the excess cement to the gel-like set. The excess cement was then very easily removed (Figure 4). The bioactivity and the ease of use of ACTIVA BioACTIVE-CEMENT make it an excellent choice, not just for geriatric applications like this, but also for many other indirect restorations where recurrent caries is a concern.

Easy clean up after flash cure

About Dr. Susan McMahon
Dr McMahon, an University of Pittsburgh School of Dental Medicine graduate, is in private practice in Pittsburgh and at University Dental Professionals in Chicago. She is an accredited member of the American Academy of Cosmetic Dentistry, the American Society for Dental Aesthetics, and a fellow in the International Academy of Dental Facial Esthetics. She is the Director of Product Evaluation for Catapult Education and a member of Catapult Speaker’s Bureau. She can be reached at 412.298.2734 or drsusan@wowinsmile.com.