January 10, 2018

Heroic Dentistry: Crowns for a Cancer Survivor

By Jack D Griffin, DMD

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.

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 bioactives have 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.

December 18, 2018

Direct from the Operatory: Bulk Filling with ACTIVA BioACTIVE-RESTORATIVE

By Dr. Eyal Simchi

The ten-year-old patient had multiple carious teeth, both anterior and posterior. He had a high level of caries risk due to poor home care and diet.

Decay is removed and tooth is prepared. There is an extended preparation to cover decalcified areas.

Tooth #7 had MLF decay including decalcification along the cervical third of the tooth. The patient was anesthetized with 1cc of Septocaine 4% (Articaine HCI w/Epi) 1:100,000 and the tooth was isolated with a rubber dam. The decay was excavated with a high speed diamond bur (Microdont 2136) and refined with low speed round carbides. The preparation was rinsed before application of a universal self-priming dental adhesive (Prime & Bond Elect, Dentsply). After bonding, the tooth was fitted with a Bioclear Matrix (I use small anterior #A-103 in most cases) to help contour the restoration. The preparation was bulk filled with ACTIVA BioACTIVE-RESTORATIVE and light cured from both sides (Valo light, Ultradent).

The preparation is bulk filled with ACTIVA BioACTIVE-RESTORATIVE (Pulpdent) and slightly overfilled.

The restoration was polished using fine diamonds and finished with a carbide bur. The final restoration blends well and polishes beautifully.

Shows initial finishing and polishing.

Final restoration with ACTIVA BioACTIVE-RESTORATIVE.

About Dr. Eyal Simchi
Dr. Simchi is a board certified pediatric dentist in private practice in Elmwood Park, NJ. As one of ten children and with five of his own, he is well suited for his chosen specialty.

December 5, 2018

Direct from the Operatory: ACTIVA BioACTIVE-BASE/LINER

By Dr. Arthur Volker

Following caries removal and toileting of the preparation (Figures 1 and 2), the ACTIVA BioACTIVE-BASE/LINER is placed directly over the deepest dentinal areas in increments of 2mm (Figure 3). Each layer is subsequently light cured.

Figure 1. Pre-operative view demonstrating gross caries. Patient had been experiencing pain at #11.

Figure 2. Preparation showing extent of caries and pulpal involvement.

Figure 3. Placement of ACTIVA BioACTIVE-BASE/LINER over pulpal area.

The tooth is etched, bonded, and then restored via a combination of flowable and micro-filled with composite.

Figure 4. Five month post-operative view. The patient reports no pain or discomfort.

 

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.

November 29, 2018

Christie Bailey Joins Pulpdent Team

Pulpdent Corporation is pleased to welcome Christie Bailey in the position of Manager of Professional Relations and International Sales.

Christie Bailey uses a combination of strategy, data analysis and creative problem-solving to identify customer needs and deliver thoughtful resolutions. She is responsible for overseeing Pulpdent’s KOL network and international sales development. Prior to Pulpdent, Christie worked for PDT, Inc. (Paradise Dental Technologies), where she was successful in branding, high level marketing strategy and global sales leadership.

Christie will work closely with Larry Clark, Director of Clinical Affairs and Marketing at Pulpdent, who comments that “in the nearly three years I have known Christie, she has proven herself to one of the most professional and personable individuals I have met in my career. Very genuine and very smart, she listens and learns. Christie has been a bright light for many. I’m truly excited to have her as part of our Pulpdent team.”

Christie holds a BA in Psychology, with a minor in English Language & Literature from the University of Montana, where she was involved in founding a non-profit health collaborative. She is passionate about health and wellness and studied Yoga and holistic healing in India.

About PULPDENT® Corporation 
PULPDENT® Corporation is a family-owned dental research, manufacturing company and leader in bioactive dental materials. ACTIVA BioACTIVE™, developed by PULPDENT, is a bioactive restorative material that behaves much like natural teeth and stimulates the formation of apatite (the building blocks of teeth), chemically bonds to teeth and helps protect against decay. PULPDENT celebrates its 70th anniversary this year with continued commitment to product innovation, clinical education and patient-centered care. To stay updated on bioactivity and learn about the Heroic Dentistry Series, which demonstrates ACTIVA’s unprecedented capabilities, visit the Pulpdent blog.

November 12, 2018

Avoid Reseals with Embrace Sealant

By Amber Auger RDH, MPH

When it comes to preventing tooth decay, dental sealants play a primary role. The pits and fissures of the teeth account for 80% to 90% of the total caries in permanent teeth and 44% in primary teeth.1 Selecting a sealant material that has proper integration with the tooth will prevent open margins, chipping, and the need for resealing. The goal of prevention is to preserve the enamel of the tooth, without having to re-treat.

Sealant Longevity
The effectiveness of the sealant is directly related to how long the sealant is retained in the mouth.2 While most resin-based materials have a high retention rate, they can be challenging to use in the moist environment. Additionally, most resin-based pit and fissure sealants contain Bis-GMA, which is not moisture tolerant.2 Therefore, selecting a sealant material that is hydrophilic (moisture-tolerant) will provide the optimal retention.

Retention Rates
Researchers estimate that 5% to 10% of sealants require repair or replacement annually.1 This poses a concern for patients that do not have the resources to be evaluated yearly, as a compromised sealant could increase the risk of chipping and microleakage. Therefore, selecting a sealant material that is long lasting and integrates with the tooth is essential to the prevention of tooth decay. When Embrace Wetbond Pit & Fissure Sealant was tested, studies demonstrated that 95% of the sealants maintained uniform marginal integrity and 100% of the teeth were caries-free 2 years after the initial placement.2

Effectiveness of Embrace WetBond Pit & Fissure Sealant
The main objective of a sealant is to protect the deep grooves and fissures from tooth decay. The traditional sealant contains Bis-GMA and requires a totally dry enamel surface, which is virtually impossible when working with pediatric patients. Embrace WetBond Pit & Fissure Sealant is a unique, moisture-tolerant resin-based sealant that contains no Bis-GMA and no Bisphenol A.2 Embrace is wet-bonding, tooth-integrating, provides better retention, a superior marginal seal, and increased fluoride release.3

Incorporating preventive materials that are designed to work in the moist oral environment, with superior integration, moisture-tolerance, and fluoride release is critical for providing the highest quality of care. Avoiding retreatments will not only preserve the enamel but also provide greater patient trust in the provider. Embrace Pit & Fissure Sealant is designed to work with the natural oral environment to preserve enamel and promote oral health.

  1. Sreedevi A, Mohamed S. Sealants, Pit and Fissure. [Updated 2017 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448116/
  2. Prasanna Kumar Bhat, Sapna Konde, Sunil N. Raj, and Narayan Chandra Kumar. Moisture-tolerant resin-based sealant: A boon. Contemp Clin Dent. 2013 Jul-Sep; 4(3): 343–348. doi: 10.4103/0976-237X.118394
  3. Bhat PK, Konde S, Raj SN, Kumar NC. Moisture-tolerant resin-based sealant: A boon. Contemporary Clinical Dentistry. 2013;4(3):343-348. doi:10.4103/0976-237X.118394


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.

November 7, 2018

Direct from the Operatory: ACTIVA BioACTIVE-RESTORATIVE

by  Dr. Susan McMahon

The patient is a healthy, 28-year-old woman with a very low caries rate. She has had staining in the pits and fissures of posterior molars for many years (Figure 1) and has recently begun to experience sensitivity in her upper left molars.

Figure 1. Shows staining in the pits and fissures of posterior molars

Visual inspection revealed staining in the pits and fissures of the upper left first and second molars. Traditionally, a clinical exam with a sharp explorer would be performed. Recent findings from light-microscopic studies have confirmed that using a sharp dental probe for occlusal caries detection causes enamel defects. Therefore, dental probing should be considered as an inappropriate procedure and should be replaced by a meticulous visual inspection.1 The CamX Triton (Air Techniques) uses fluorescence to evaluate and calibrate demineralization and decay. In Figure 2 the numerical value (1.6) and color coding indicate incipient enamel caries (blue) with deep enamel caries (red).   The deep enamel decay was removed with a disposable #330 carbide bur (Microcopy) and the surrounding incipient enamel decay was prepared with a Fissurotomy Bur (SS White).

Figure 2. The CamX Triton (Air Techniques) uses fluorescence to evaluate and calibrate demineralization and decay. The numerical value (1.6) and color coding indicate incipient enamel caries (blue) with deep enamel caries (red).

The preps were cleaned and rinsed with Consepsis (Ultradent). The enamel was etched with 37% Phosphoric Acid, rinsed and lightly dried and then the adhesive was applied and cured. Placement of ACTIVA BioACTIVE-RESTORATIVE was easy and precise with the bendable applicator tip (Figure 3). The applicator tip was used to carry and drag the material for anatomic placement and very little finishing was needed.

Figure 3. After caries removal, selective etching of enamel and bonding, placement of ACTIVA BioACTIVE-RESTORATIVE is easy and precise with the bendable tip.

Figure 4 shows the final restoration, which is esthetic, very conservative, durable and releases ions.

Figure 4. Final restoration with ACTIVA BioACTIVE-RESTORATIVE.

 


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.