This CE webinar continues the discussion of biomimicry and bioactivity in dental materials and their clinical applications, and will also introduce a new category restorative material. At the end of this CE webinar the participant will be able to understand the concept of biomimicry and the role of so-called bioactive materials that functionally replace those ions lost in the decay process, and will also be able to implement techniques for truly restoring a tooth. Participants will be more familiar with the materials available and how to best utilize them in various treatment modalities, especially for pediatric and geriatric populations. Techniques will be discussed so that the participant can readily and easily incorporate the materials into their restorative protocols.
About Dr. Howard Glazer Dr. Glazer 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 (Bronx, NY). He has been a visiting clinician at several universities around the country. He is a Fellow of the American College of Dentists; International College of Dentists; American Society for Dental Aesthetics, the American Academy of Forensic Sciences, and a Diplomate of the American Board of Aesthetic Dentistry. Dr. Glazer is an Attending Dentist at the Englewood Hospital (Englewood, NJ). Additionally, Dr. Glazer is the Deputy Chief Forensic Dental Consultant to the Office of Chief Medical Examiner, City of New York.
In this video Dr. Howard Glazer and Larry Clark discuss the clinical benefits of ACTIVA Presto. “Look what you did! You gave me a single syringe,” says Dr. Howard Glazer, adding that ACTIVA Presto is “squirt and shoot technology. I’m loving it!”
*Please note that ACTIVA Presto is only available in the United States at this time.
Next month Pulpdent will be launching ACTIVA Presto, the first light cure composite designed to mimic the properties of natural teeth. Using the tooth as the standard, Pulpdent has developed a material that is esthetic, high strength, moisture-friendly and contains no Bis-GMA, no Bisphenol A and no BPA derivatives.
The magic of ACTIVA Presto is in the resin, which is hydrophilic and facilitates the diffusion of bioavailable calcium, phosphate and fluoride ions. “It’s acting just like a tooth,” explains Larry Clark, Director of Clinical Affairs at Pulpdent, “it’s giving off and taking back ions.” This unique chemistry penetrates and integrates with tooth structure for margin-free adaptation. The material also contains a patented rubberized-resin that absorbs stress and resists wear, fracture, and chipping, even in thin areas on bevel margins.
ACTIVA Presto is a stackable composite that holds its shape and will not slump. This versatile material is indicated for all classes of cavities and comes in a variety of shades, including cervical shades A4 and A6, which are ideal for older patients. ACTIVA Presto is highly radiopaque (250%) and comes in easy to use 1.2 mL syringes.
ACTIVA Presto will be available to purchase in the United States starting in January 2020. The magic is coming!
To place an effective Class V restoration, it is important to understand how teeth absorb and distribute stress. According to Milicich and Rainey, “stress distribution in human tooth structure can be visualized through the use of Moiré fringes,” which show the “peripheral rim of enamel transferring occlusal load directly to the root of the tooth.” The load on the incisal edge of a tooth moves vertically and then horizontally to the DEJ before transferring vertically and accumulating in the Class V area where the enamel is at its thinnest (approximately 0.3 millimeters). The cervical third of the tooth absorbs the greatest stress, which can cause adhesive delamination.
To ensure best outcomes in Class V restorations, I have started using ACTIVA BioACTIVE-RESTORATIVE, which contains a patented rubberized resin that is more fracture resistant than traditional composite materials. According to the manufacturer the toughness of ACTIVA, measured by deflection at break, is 2-3 times greater than composites and 5-10 times greater than GIs and RMGIs. The material exhibits high compressive and diametral tensile strength while also having very low wear. In addition, ACTIVA BioACTIVE is hydrophilic, making it ideal for Class V restorations and other instances where it is difficult to ensure a dry field.
The patient presented with several failing Class V restorations. The pre-operative image of tooth #8 indicates a cervical abfraction and failing composite restoration (Figure 1). The tooth was prepared using rotary abrasion with the goal of exposing prismatic enamel to promote micromechanical retention and leverage the bond strength of enamel. Figure 2 shows the preparation with a radius bevel.
The peripheral rim of enamel around the Class V restoration can be considered a tension ring (Milicich G & Rainey J) which, when properly reinforced, can mitigate the occlusal forces accumulating in the Class V area. Similar to caulking a window, an adhesive seal was placed around the preparation (Figure 3). The adhesive was placed first on the gingival margin followed by a 10 second light cure, then the top of the “window” was “caulked” and sealed with a 10 second light cure, and finally each side was “caulked” and sealed before light curing for 10 seconds. After “caulking the window” the final restoration was placed using ACTIVA BioACTIVE-RESTORATIVE. The material was back filled into the preparation and placed slightly beyond the radius bevel, and then finished and polished. Figure 4 shows the final restoration.
Reference Milicich G, Rainey J. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. PPAD 2000; 12 (7): 695-700.
About Dr. Frank J. Milnar
Frank J. Milnar DDS, AAACD is a graduate from the University of Minnesota, School of Dentistry in 1976. He is an Accredited member of the American Academy of Cosmetic Dentistry, Board Examiner for Accreditation and Diplomat of the American Board of Cosmetic and Esthetic Dentistry. Dr. Milnar maintains a full-time practice in St. Paul, Minnesota emphasizing Minimally Invasive and appearance related dentistry. He has published over 50 peer reviewed articles about the direct placement of composites, shade selection and porcelain materials and is on editorial review boards for dental journals. Dr. Milnar is co-founder of the Minnesota Academy of Cosmetic Dentistry and has lectured extensively within the US Armed Forces as well as internationally on the subject of direct composite restorations, shade selection and porcelain materials. He has been voted “Top Dentist” and voted into the” Top Dentist Hall of Fame” for the last five years by his peers in the Minneapolis/St. Paul Magazine.He has been voted by Dentistry Today as one of the top 100 dentists contributing to dental education. Most recently, Dr.Milnar was nominated to the University Of Minnesota School Of Dentistry Continuing Education Advisory Board and is a Visiting Faculty Member for the BIOCLEAR Learning Center.
As a practicing hygienist, I come across a lot of misconceptions about treatment options, especially fluoride varnish. Here are the top four myths I’ve heard about fluoride varnish and what you need to know:
Myth #1: It’s all about the flavor From Salted Caramel to Tutti Frutti, fluoride varnishes are available in a dizzying array of flavors. While great taste can help increase case acceptance, it is not the only factor to keep in mind when selecting a fluoride varnish. Consider the other ingredients in the varnish and the role they play in reducing the risk of dental decay.
Myth #2: Fluoride is the key ingredient Fluoride is one of several important ingredients to look for in a fluoride varnish, including:
Calcium and Phosphate During demineralization it is calcium and phosphate ions, not fluoride, that are released by the tooth. When the process of demineralization happens more quickly than remineralization, subsurface lesions develop, leaving the patient susceptible to tooth decay. The appearance of a white spot lesion indicates that, while subsurface mineral content has been lost, there is still potential for remineralization. The combination of calcium, phosphate, and fluoride help support remineralization and preserve tooth structure.
Xylitol Xylitol promotes an increased salivary flow and a balanced pH which work to reduce the number of cariogenic and periodontopathic bacteria. The use of xylitol has been shown to lead to a reduction in the proportion of streptococci mutants in plaque, neutralize plaque acids, and help remineralize white-spot lesions.
Myth #3: More is better Counterintuitive as it may seem, using more fluoride varnish is not necessarily better. Patients tend to be less compliant when they have multiple layers of fluoride varnish on their teeth. Some may even chip away at a varnish treatment that feels “thick” or uncomfortable. To ensure patient compliance, the varnish should be uniformly mixed and placed in a thin, even layer, so that it can dry quickly.
Myth #4: Parts Per Million (PPM) Determines Efficacy Many varnishes contain a high concentration of parts per million of fluoride (usually 22,600 PPM) in order to extend the contact time between fluoride and tooth surfaces. Research shows that it is the mechanism of action, rather than the parts per million of fluoride ions, that matters most. This mechanism involves interaction of fluoride from the varnish with saliva to form calcium fluoride (CaF2). The CaF2 deposits slowly release fluoride ions into the oral environment, supporting the natural remineralization process.
Collins, Fiona. The Development and Utilization of Fluoride Varnish. 2014. Available at: https://www.dentalacademyofce.com/courses/2093/PDF/1106cei_varnish_web4.pdf. Accessed October 23, 2018.
Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit xylitol campaign, a new approach in oral health promotion. Community Dent Health. 1995;12:230–234.[PubMed]
A Maguire, A J Rugg-Gunn. Xylitol and caries prevention — is it a magic bullet? British Dental Journal volume194, pages429–436 (26 April 2003)
Gold, J. Fluoride Varnish Products in the U.S. Market. J Res Development 2013. DOI: 104172/2311-3278.1000e102. Accessed November 6, 2018.
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.