Pulpdent has launched
a new continuing education (CE) podcast on bioactive and biomimetic dental
materials. Hosted by Viva Learning’s DentalTalk, the four-part series provides
1 CEU and is available on iTunes and Stitcher.
In the second episode, host Dr. Phil Klein interviews
Pulpdent’s Director of Clinical Affairs and Marketing, Larry Clark about the
clinical applications for bioactive and biomimetic products, as well as the
benefits and challenges associated with these types of products.
Click here to listen to the first episode.
the first episode, host Dr. Phil Klein interviews Pulpdent’s Director of
Clinical Affairs and Marketing, Larry Clark about bioactivity and biomimicry in restorative
dentistry. Klein and Clark explore the reasons for restoration failure, alternatives
to traditional restorative materials, and the concepts of bioactivity and
The focus on prevention has reduced the incidence of caries in many
western countries; however, we continue to observe a high rate of dental disease
and decay. This is largely due to intrinsic conditions, such as gastro-esophageal
reflux and gastric regurgitation (bulimia), and extrinsic dietary causes, such
as continuous snacking, high sugar products, and soft-drinks that contain high
levels of sugar and acids, which are known to cause aggressive enamel
A 46-year-old male was referred to my office with serious decay and
hypersensitivity to cold. His patient history indicated he had undergone stomach
constriction surgery to treat obesity. It also revealed a propensity for frequent
consumption of a famous carbonated beverage with high erosive potential.2
The patient comes from a middle class socio-economic and cultural background.
He is aware of the serious condition of his teeth, but he has no idea of the
reasons for his condition. He reported to me that he brushes every day and is
careful to practice good oral hygiene, even if he did not schedule regular
visits to the dentist. It was only when he experienced hypersensitivity that he
took a close look in the mirror and observed the clearly visible damage to his
teeth. His major concerns were how this condition affected his smile and the
impact of hypersensitivity on his quality of life. He was embarrassed by his teeth,
and he could no longer tolerate cold food or drinks.
An initial examination showed large areas of demineralized enamel and
exposed dentin, especially in the cervical area (Fig. 1). The extensive caries
process could easily be traced to gastric regurgitation as consequence of
stomach reduction surgery,3 and the frequent consumption of soft drinks.
I explained these causes and established the treatment plan. The patient
was instructed to immediately modify his dietary habits and eliminate soft
drinks; he was referred to a gastro-intestinal specialist to address the acid
reflux episodes; he was instructed to rinse with sodium bicarbonate solution
after each gastric regurgitation episode and avoid tooth-brushing after these
episodes to prevent loss of demineralized and fragile superficial enamel;4
and he was placed on a fluoride-based mouthwash regime.
I restored the teeth using a mild self-etch adhesive and a conventional
composite resin. However, at a 6-month recall visit, I noticed secondary caries
at the restoration margins. Although improvements had been made in the
patient’s diet and gastro-esophageal disorder, these had not been fully
Information on research and advances in dental materials are now readily
available through journals, educational programs, and online portals. Through
these sources I learned about an esthetic, bioactive, restorative material with
a durable resin matrix (ACTIVA, Pulpdent Corporation, Watertown MA, USA). The
material releases calcium, phosphate and fluoride ions5 that offer
protection to the restorative-tooth interface, which is where secondary caries
I removed the conventional composite restorations on the teeth affected
by secondary caries, selectively etched the enamel, applied a self-etch bonding
agent, and restored the teeth with ACTIVA (not shown).
At this visit, I observed that a new active carious lesion had developed
on the distal of the upper right lateral incisor (Fig. 2). This tooth had not
been previously restored, and I treated this lesion with the bioactive material
The patient is still under my care, and the restorations placed with ACTIVA
bioactive material did not show any staining or secondary caries at the
one-year recall visit (Fig. 6).
The patient continues to show improvement. The gastro-esophageal
regurgitation disorder has been reduced, and the patient follows the prescribed
rinsing protocol after each episode. He has completely removed the erosive soft
drink from his diet.
Patient history and patient education provide information to both the clinician and the patient that is essential for success. Lifestyle changes and medical interventions may be necessary to achieve desired outcomes. The restorative materials with bioactive properties could be a valid choice – and an alternative to the conventional procedures – in patients exposed to dental erosion, either of an intrinsic or extrinsic nature.
1. Carvalho TS, Colon P, Ganss C, Huysmans MC,
Lussi A, Schlueter N, Schmalz G, Shellis PR, Björg Tveit A, Wiegand A. Consensus report of the European Federation of
Conservative Dentistry: erosive tooth wear-diagnosis and management. Swiss
Dental Journal 2016:126; 342 – 346.
2. Kitasako Y, Sasaki Y, Takagaki T, Sadr A, Tagami J. Multifactorial
logistic regression analysis of factors associated with the incidence of
erosive tooth wear among adults at different ages in Tokyo. Clin Oral Investig 2017 Feb 7. doi: 10.1007/s00784-017-2065-7. [Epub ahead of print]
RP, Carmichael RP, Marcon MA, Sandor GK. Dental erosion in gastroesophageal reflux
disease. J Can Dent Assoc 2003;69:84-89.
4. Yip KH, Smales RJ, Kaidonis JA. Case report: management of tooth
tissue loss from intrinsic acid erosion. Eur J Prosthodont Restor Dent 2003;11:101-106.
5. 45. Evaluation of pH, fluoride and calcium release for dental
materials. Morrow BR, Brown J, Stewart CW, Garcia-Godoy F. J Dent Res 96 (Spec
Iss A) 1359, 2017 (www.iadr.org).
Hygienist, educator and public health advocate
Sherri Lukes will present Flavor Vs Function: A Look at
Rationale for Fluoride Varnish Product of Choice, a Continuing
Education (CE) webinar on June 18, 2019 at 7:00 PM ET / 4:00 PM PT.
This CE webinar offers an overview of factors to consider when selecting a fluoride varnish product. Flavor aspects will be presented with a conversation about taste as the current primary determinant for product choice. The benefits of additional ingredients in fluoride varnish will be discussed as well as other characteristics for superior patient benefit. The entire dental team can profit from information concerning fluoride varnish choices for best patient care. This free CE Webinar will be available for On-Demand viewing after June 18, 2019 on www.pulpdentlearning.com
About Sherri M Lukes, RDH, MS,
author and public health advocate, Sherri Lukes has been a hygienist for 37
years. Most of her career has been in academia, retiring in 2014 as associate
professor from Southern Illinois University where she taught oral pathology,
public health and multicultural dental hygiene. Research efforts were
concentrated in migrant farmworker oral health, oral pathology, and issues of other
underserved populations. Mission work is a passion that was shared with her
students for years and she continues to offer the opportunity for students and
faculty to participate in bi-annual trips.
As professor emerita, Sherri is
fortunate to be able to now integrate years of experience into CE courses to
empower dental professionals in the process of care. She offers courses
on oral pathology, cultural competence and older adult oral health. She can be
reached at email@example.com.
Embrace Esthetic Opaquers (Pulpdent) are the best opaquers I have ever used. They are a near perfect match to Vita shades, resulting in very consistent and predictable clinical outcomes. The Embrace resin technology makes the opaquers much less likely to dissolve or come off the substructure when they are treated with bonding agents. A very thin layer is all that is required and light cures in 20 seconds.
In this case, we are about to cover an old, long metal post that I did not dare to remove (Figure 1). The goal was to complete a composite core build-up over the post so a porcelain crown could be placed as a final restoration without any sign of the metal post showing through.
I find it easiest to use an explorer to place the opaquer on the substructure I want to cover. In my experience, the pink opaquer covers metal exceptionally well. Another layer can be added in a shade if desired. Total etch and bond can then be used to adhere a core material to the opaqued post and the tooth (Figure 2). The result (Figure 3) completely hides the metal post so that a ceramic crown can be constructed with natural translucency, rather than using a very opaque crown which would look less natural.
About Dr. Marty Zase Dr. Marty Zase received a B.A. from Boston University and his D.M.D. from Tufts University School of Dental Medicine. A former clinical instructor in restorative dentistry at Tufts, he is guest lecturer in cosmetic dentistry. He has published over sixty dental articles, has served on the editorial or review boards of The Journal of Cosmetic Dentistry, Contemporary Esthetics, and General Dentistry magazines, and lectures internationally on cosmetic dentistry.
He is one of only
about a dozen dentists in the world to have both a Mastership from the Academy
of General Dentistry and an Accreditation in Cosmetics from the American
Academy of Cosmetic Dentistry. He practices in the Colchester Dental Group and
is the only dentist in the greater Hartford area Accredited by the AACD.
Dr. Zase has developed
numerous techniques and instruments that are currently used in modern cosmetic
dentistry. He has been strongly
recognized for his contributions to dentistry and dental education. Dr. Zase has been selected by Dentistry Today
magazine as one of the Top Clinicians in Dental Continuing Education for the last
eleven years in a row.
Salierno of Dental Economics stopped by the Pulpdent booth at the Chicago
MidWinter Meeting to learn about biomimicry from Larry Clark, Director of
Clinical Affairs at Pulpdent. The following video captures their conversation.