October 10, 2018

Direct from the Operatory: Tuff-Temp Plus

by Robert A. Lowe, DDS

In the clinical environment, an artistically contoured and well-marginated provisional restoration nurtures the gingival tissues with proper marginal seal and emergence profiles during the interim phase of treatment. A provisional matrix can be fabricated from the pre-operative stone model /  composite mock up using a clear plastic stent material and a thermoplastic suck down device. After the teeth are prepared (Figure 1), Tuff-Temp Plus is dispensed into a matrix and placed on the prepared teeth for approximately two minutes.  Once the Tuff-Temp Plus provisional shell is recovered from the matrix, a sharp lead pencil is used to delineate margins and the contact zones proximally, so they are not accidentally damaged during the trimming process. 

Figure 1. Teeth are prepared for provisional material

Specially selected instrumentation is utilized to artistically carve the morphologic tooth replicas (Figure 2). 

Figure 2. Instrumentation is used to carve morphologic tooth replicas

An ultra thin, safe-sided diamond is used to make the initial cut between units as the gingival embrasures are developed and later to delineate separation between units developing facial and lingual embrasure form (for multi-unit provisional restorations).  An impregnated composite polishing brush or medium grade pumice on a chamois wheel is then used to polish the finished restoration.  A final luster is achieved using a small, dry muslin wheel.  Finally, Tuff-Temp glaze is painted on the surface of the restoration with a fine sable brush, and then light cured. This glaze is also included with Tuff-Temp Plus Provisional material as is the add-on flowable material (Figure 3).

Figure 3. Tuff-Temp Plus Add-On flowable material is applied as needed

Figure 4 shows the final provisional restoration.

Figure 4. Final provisional restoration

 


About Robert A. Lowe, DDS
Robert A. Lowe, DDS, received his Doctor of Dental Surgery degree from Loyola University School of Dentistry. After completing his residency, Dr. Lowe went into private practice and began to pursue another passion: clinical teaching. While running his own practice, Dr. Lowe served as a Clinical Professor in Restorative Dentistry at Loyola University School of Dentistry until its closure in 1993. In 2000, he relocated to Charlotte, NC.

September 25, 2018

284 Embrace Sealants Provided to Joe Hartman School Students

By Amber Auger RDH, MPH


For the past twenty-eight years, Professor John Power of Quinnipiac College  has brought volunteer teams to the Dominican Republic to provide free healthcare, primary school education, construction services, and meals to the underserved community of La Romania. This year, I was fortunate to lead a team of four dental hygienists to provide oral hygiene and prevention services. Preventive care is new to this community, where dental care has been limited to extractions. My team was stationed at the Joe Hartman School and worked out of a mobile unit equipped with the tools needed to provided preventive education, cleanings, and sealants. Pulpdent’s Embrace Pit & Fissure Sealant was used to place 284 sealant treatments.

History of Joe Hartman School
Pastor Elza Phanord and her late husband, Rev. Jean Luc Phanord, had a vision: build a school for the poor in the Dominican Republic to give local children an excellent education and to teach them Christian values. With much volunteer work, donations, and prayer, the vision became real and the Joe Hartman School opened along Kilometer 6 in the Dominican Republic.1 There are over 150 children who attend the school, which is mostly sponsored by Americans. To learn more information about sponsoring a student click here.

Innovation of Embrace
Despite the extreme heat, the Embrace Pit & Fissure Sealant material remained uncompromised. The hydrophilic material allowed clinicians to have extreme efficiency and accuracy. Utilization of Embrace Sealant resulted in long-term protection of the molars. Prior to our time at the school, the children never had access to preventive services. Additionally, Embrace Fluoride Varnish was placed after the prophylaxis and sealants.

Collaboration with Local Dentists
While on the trip, our team build a trusting relationship with the local dentists. With the help of our translators, we were able to discuss the differences in the preventive mindset of the dental hygienists and their crucial role in the long- term health of the patient. Our team also provided preventive services to the local dentists.

The patients that we treated over the week-long mission trip were educated on the importance of oral hygiene and prevention. Our team will be returning to the Dominican Republic next year to provide additional preventive services and education.

 

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.

 

September 10, 2018

Dr. Arthur Volker Presents CE Webinar on Minimally-Invasive Dentistry

Well-known dentist and educator Dr. Arthur Volker will present “Minimal Intervention, Maximal Outcomes: The Use of Minimally-Invasive Dentistry to Maximize Esthetic and Functional Outcomes,” a free CE webinar on October 4, 2018 at 7:00 PM ET/ 4:00 PM PT. 

Sign up for Dr. Volker’s Free CE Webinar

The webinar will focus on minimally-invasive dentistry, which Dr. Volker describes as “a hot topic” among oral health care providers. Dr. Volker explains that, for many dentists, it is very easy to talk about taking away less tooth structure, but it is more difficult to apply this concept to achieve predictable, esthetic, and functional results. The upcoming CE webinar offers insights on how clinicians can successfully and immediately expand the use of minimally-invasive dentistry in daily practice.

Dr. Volker’s free CE webinar “Minimal Intervention, Maximal Outcomes” will be available for On-Demand viewing after October 4, 2018 on www.pulpdentlearning.com.

 

About Dr. Arthur Volker
An experienced clinician and educator, Dr. Volker graduated from Colombia University’s School of Dental and Oral Surgery, and completed a General Practice Residency at the New York Hospital of Queens. He is an attending clinician at Coler-Goldwater Specialty Hospital and Nursing Facility and serves as Vice-Chairman of the hospital’s Graduate Medical Education Committee. Dr. Volker was the recipient of the esteemed Fellowship Award from the Academy of General Dentistry, where he serves as the Academy’s Vice President of Queens, and is Chairman of the New Dentist Committee.

September 9, 2018

Heroic Dentistry: Saving Teeth with Bioactive Materials

By Dr. Josh Wren

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.

Stacey is an 8-year old twin with congenitally missing teeth, which is not uncommon for twins. She is also my neighbor and the daughter of my wife’s best friend. Four years prior, Stacey had hypocalcified and decayed primary molars restored under general anesthesia due to high anxiety. She presented to my office with a hypocalcified upper right first permanent molar (tooth #3) (Figure 1) which also had deep decay. The molar appeared hopeless, and another dentist recommended extraction, but her parents were rightfully concerned about her losing another tooth.

Figure 1: Pre-operative radiograph (contrast inverted) from May 2014 shows deep decay near the pulp in tooth #3 (upper right 1st permanent molar). The tooth was asymptomatic.

My concerns were the restorability of the tooth, the status of the pulp, and the potential longevity if I placed a direct restoration instead of a stainless steel crown. Stacey’s mother did not want another stainless steel crown, especially on a permanent tooth. 

I did not want to place a traditional inert material in this compromised tooth. Traditional composites are subject to leaking, and preventing microleakage was imperative to ensure long-term success. My materials of choice were MTA, ACTIVA Base/Liner, and ACTIVA Restorative for the final restoration due to its wear resistance, toughness, and release of minerals conducive to sealing and preventing marginal leakage.

With gentle behavior guidance and nitrous oxide, the treatment was completed with zero behavior issues. I was concerned about pulpal exposure or pulpal response to the trauma of the deep cavity preparation and materials, so I took a cautious two-step approach. During the initial excavation appointment, I left more infected dentin behind than I normally would, placed a one-minute application of silver diamine fluoride, and temporized with a glass ionomer cement (Figure 2). 

Figure 2: When the patient returned 2 months later, the glass ionomer cement was no longer intact; however, the tooth was still completely asymptomatic.

At the two-month return date, I reopened the carious lesion, removed more infected dentin (Figure 3) until I reached semi-solid dentin (Figure 4), and placed NuSmile NeoMTA (Figure 5), which is impenetrable and resists leakage. I completed the final restoration with ACTIVA BioACTIVE-BASE/LINER and ACTIVA BioACTIVE-RESTORATIVE and was confident I had created the best possible seal against microleakage for a direct restoration.

Figure 3: Re-opened cavity with infected dentin which was stained black due to the silver ions from silver diamine fluoride.

Figure 4: Carious dentin was removed and the area was cleaned with a sodium hypochlorite scrub, taking care to thoroughly excavate all decay at the DEJ but to avoid pulpal exposure. The root apices were not fully closed at this time. Personally, I would view this restoration as a success if I could simply get the root apices closed prior to any endodontic intervention.

Figure 5: Shows placement of NeoMTA (NuSmile), followed by a 1-2mm cured layer of ACTIVA BioACTIVE-BASE/LINER to protect against MTA washout during the acid etching and bonding procedure.

Figure 6: The tooth was selectively etched and VivaPen bonding agent (Ivoclar) was applied. A 2mm initial base layer of ACTIVA BioACTIVE-RESTORATIVE was placed and light cured before bulk filling the remaining preparation with ACTIVA BioACTIVE-RESTORATIVE.

I have followed this case for more than three years. The pulp remains healthy, there is no sensitivity, and no marginal breakdown of the ACTIVA restorative materials. Not only is the tooth asymptomatic, but there is also radiographic evidence of a layer of reparative dentin between the restorative materials and the pulp chamber (Figure 7). Once again we see that the tooth can truly repair itself with the correct diagnosis, a conservative treatment plan, and the use of bioactive materials.

Figure 7: Three-year follow-up radiograph from June 2017 shows arrested lesion and the deposition of reparative dentin. The tooth was asymptomatic with complete root formation at the time this radiograph was taken. Orthodontic treatment is now underway for the mal-eruption of the upper right first bicuspid and multiple missing teeth.

About Dr. Josh Wren
Dr. Wren practices pediatric dentistry in Brandon, Mississippi. He is the founder of Pediatric Dental Seminars, which serves to educate general dentists on topics related to pediatric dentistry through lecture based seminars and hands on workshops. 

September 5, 2018

Pulpdent Corporation and Virtudent Increase Access to Dental Care for New Hampshire Children

Pulpdent Corporation is working in collaboration with Virtudent, the first commercial teledentistry practice in the United States, to increase access to dental care for low-income children in New Hampshire. Pulpdent has donated 800 applications of Embrace Varnish for Virtudent’s program at the Boys and Girls Clubs of NH.

According to the CDC, over 15% of children and adolescents aged 2-17 did not see a dentist in 2015. As a result, thousands of children are rushed to the emergency room every year for preventable dental problems.

Virtudent’s research suggests that low-income youth lack access to dental care due to the uneven distribution of dentists in the United States and the relatively small number of dentists who accept Medicaid. The teledentistry practice, which specializes on-site dental visits for participating companies, is bringing its innovative care model to the Boys and Girls Clubs of New Hampshire. Virtudent currently offers on-site dental care and teledentistry services to 4,200 children at 8 Boys and Girls Clubs locations throughout the Granite State.

The majority (88%) of Virtudent’s on-site dental appointments at the Boys and Girls Clubs of New Hampshire include a Fluoride Varnish treatment. Pulpdent has donated 800 applications of Embrace Fluoride Varnish to Virtudent’s program for the Boys and Girls Clubs of NH. While many commercially available fluoride varnishes only contain fluoride, Embrace Varnish releases fluoride, calcium and phosphate (the basic building blocks of teeth). These essential minerals help strengthen teeth. 

A Virtudent staff member applies Embrace Varnish to a child at a Boys and Girls Club in New Hampshire.

August 16, 2018

ACTIVA BioACTIVE-CEMENT Receives Top Rating from REALITY

ACTIVA BioACTIVE-CEMENT received the top rating from REALITY in the “Resin Cements – Dual-Cured Only – Self-Adhesive” category.

Click here to read REALITY’s review of ACTIVA BioACTIVE-CEMENT.

ACTIVA-BioACTIVE Cement

Some traditional, non-bioactive dental cements can wash away over time, leaving teeth vulnerable to acid attack and additional decay. The result can be painful and costly for patients, who find themselves needing replacement crowns or, if the decay is extensive, a root canal treatment or even a dental implant.

Bioactive cements offer a better solution for the patient:

  • Bioactive dental cements help protect teeth from acid attack caused by dietary sugars. ACTIVA BioACTIVE-CEMENT responds to pH changes in the oral environment through a release and recharge of calcium, phosphate and fluoride.
  • This unique chemistry supports the natural remineralization process with the release of calcium, phosphate and fluoride and helps form a seal between the material and the tooth.
  • This protective seal helps prevent new cavities from forming under dental crowns and bridges.

According to the REALITY review, dentist evaluators were generally pleased with the consistency and handling of ACTIVA BioACTIVE-CEMENT. Evaluators found that the cement “cleans up nicely” and used the bioactive dental cement for both single and multi-unit restorations. REALITY reported “virtually no dislodgements and post-cementation sensitivity.” One evaluator used ACTIVA BioACTIVE-CEMENT to salvage failing crowns for medically compromised patients.

ACTIVA™ BioACTIVE-CEMENT is an esthetic bioactive dental cement that imitates the physical and chemical properties of teeth. It contains no Bisphenol A, no Bis-GMA and no BPA derivatives.