By Dr. Oliver Mayoral

A new patient presented with root caries on the buccal and distal aspects of tooth #1 (Figure 1). His dentist of many years recommended an extraction, and the patient came to me for a second opinion. There is an opposing third molar, so this tooth is functional, although gaining access to restore the distal can be a challenge.

The tooth was prepared (Figure 2) and etched, followed by an application of Scotchbond Universal Adhesive (3M) and placement of ACTIVA BioACTIVE-RESTORATIVE. The ACTIVA BioACTIVE syringe has a bendable metal cannula, and this made it easy to access the distal of the third molar, which otherwise would have been much more difficult to treat. The material adapted well to the tooth and polished nicely, providing a very good result.

About Dr. Oliver Mayoral

Dr. Mayoral is a Miami native who received his Doctor of Medicine in Dentistry degree from the University of Florida College of Dentistry. As a respected leader in his field, Dr. Mayoral holds memberships in organizations that include the American Dental Association, the Florida Dental Association and the South Florida Dentists in Pursuit of Excellence. Known by his patients for his warm, comforting bedside manner, Dr. Mayoral also enjoys volunteering his dentistry services at the Lotus House and the Camillus House, both local shelters in the Miami area.

Until recently, clinicians had two options for composite viscosity, either flowable or packable. Now there is a new category of material that provides the best of both worlds: the stackable composite.

Here are three reasons why dentists are choosing stackable composites for their restorative procedures:

Ease of Placement: Stackable composites adapt to line angles and the axial walls of a cavity, especially in deep preparations. They also hold their shape and do not slump, making them ideal for areas that require layering and/or controlled placement.

Versatility: Stackable composites are indicated for all classes of restorations. Clinicians can use this one material to line the bottom of a preparation, build up the restoration and create occlusal anatomy. This simplifies clinical technique (no need for multiple composites), cuts down on waste and reduces inventory.

Strength: Stackable composites are highly filled, with strength, durability, and wear comparable to packable materials. A new universal stackable material also contains a rubberized resin that absorbs shock and resists fracture and chipping, even when applied in thin layers on beveled margins.

Interested in learning more about the latest innovations in restorative dentistry? Sign up for Pulpdent eNews.

Well-known dentist and educator Dr. Joshua Austin will present “The Provisional is the Problem!,” a Continuing Education (CE) webinar on March 18, 2020 at 7:00 PM ET/ 4:00 PM PT. This live webinar is free and open to the public.

Sign up for Dr. Austin’s webinar.

In this CE webinar, attendees will learn about:
• the importance of the provisional
• protocols for quickly fabricating great single unit provisionals
• tips and tricks for multi-unit provisionals

About Dr. Joshua Austin
Joshua Austin, DDS maintains a full time restorative dentistry private practice in San Antonio, Texas. He is an editorial director and columnist for Dental Economics focusing on dental products and technology. Dr. Austin lectures around the country to study clubs and dental meetings about these topics along with online reputation management and social media. Dr. Austin is a graduate of the University of Texas Health Science Center at San Antonio Dental School and spent five years post-graduation as faculty in the Department of Restorative Dentistry. His approach to his “Pearls for your Practice” column is a fresh approach in today’s commercially driven dental journalism. When you read a “Pearl,” rest assured that you are getting an honest evaluation of a product, which was used by Dr. Austin in clinical practice on a patient.

By Dr. Marty Zase

Pulpdent’s dual-cure ACTIVA BioACTIVE-CEMENT is a game changer. As a bioactive product, the cement not only is a superb adhesive agent but also mimics nature and utilizes saliva as a source of minerals to aid in the natural development of crystalline structure by recharging calcium, phosphates and fluoride along the margins of the crown. These apatite-like deposits fill microgaps between the crown and tooth and can help maintain marginal integrity over time. Although the use of bonding agents is stated as optional, I routinely use them on the etched and remoistened tooth preparation. The success of adhesion with this technique is at least partially due to the inclusion of a highly phosphonated eighth generation bonding agent containing MDP, which matches extremely well with Activa’s highly phosphonated resin. This means adhesion is predictable and ideal. Flow is excellent and cleanup is a breeze.

The details of my procedure for cementing with Activa cement are:

1. Clean and sandblast the intaglio surface of the crown.

2. Etch the tooth, remoisten with Microprime G (Danville/Zest), apply AllBond Universal (Bisco) but do not cure. Place ACTIVA BioACTIVE-CEMENT in the crown (no need to overfill).

3. Insert the crown. Check margins with an explorer to confirm full seat. ACTIVA BioACTIVE-CEMENT is so flowable, I just have to insert the crown, press down, and hold for two minutes. After two minutes, the ACTIVA BioACTIVE has now self-cured into a semi-solid (gel stage).

4. Tack cure for just 1-2 seconds in each direction after the gel stage is reached. Use an interproximal carver to slice off excess from tack-cured gel stage. Slicing off the excess prevents pulling out the cement that might be filling any slightly open gaps at the margin.

5. Use Glide floss (Oral-B) to slice through interproximal excess. Floss again … if there is resistance, use a ContacEZ white serrated separator (ContacEZ). Fully light cure all margins.

6. Use a sharp scaler to remove any leftover excess.

RESULTS: Very fast, minimal excess after trimming at gel stage, easy clean up.

I have not had a single crown come off after cementation.

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. 

Well-known dentist and educator Dr. Howard Glazer will present “Biomimicry Part II: The Evolution of Truly Restorative Dentistry Continues,” a Continuing Education (CE) webinar on February 12, 2020 at 8:00 PM ET/ 5:00 PM PT. This live webinar is free and open to the public.

Sign up for Dr. Glazer’s webinar.

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.