August 1, 2018

Is your practice using bioactive materials?

By Karen Comisi CDA, RDA, FADAA

It is an exciting time to be in the field of restorative dentistry. Instead of just filling holes we now have the opportunity to replace missing tooth structure with bioactive materials which can help repair teeth and reduce sensitivity while also cutting down on chair time and overhead. One such material, ACTIVA BioACTIVE-RESTORATIVE, was a game changer in our practice, and it can be for yours too.

When introducing a new technology to your practice it is important to get buy in from your team members. The staff needs to understand why a product like ACTIVA should be added to the clinical armamentarium. Here are four steps to help make the case for bioactive materials in your practice:

  1. Start with education. A great way to get the team on board is to attend a continuing education course together. When a team has the opportunity to learn together they are able to ask the necessary questions so each person understands the material and the process for placement. If you can’t attend a course together, an online webinar or “Lunch and Learn” with a company representative is an excellent way to achieve the same goal.
  2. Review the patient benefits. Bioactive materials are quite different than traditional composite restorations, and there are many benefits for your patients. ACTIVA BioACTIVE has a rubberized-resin component, so patients are less likely to experience chipped and worn-out fillings. ACTIVA also contains calcium, fluoride and phosphate to help stimulate apatite formation,1 creating a seal against microleakage, a major cause of sensitivity and restoration failure
  3. Discuss the clinical benefits. Activa is an injectable material with a delivery system that allows you to back fill your preparation and avoid air bubbles. The material is quite versatile and can be used for multiple kinds of restorations, simplifying protocols (and reducing inventory).
  4. Consider the business benefits. The ability to bulk fill this material allows you to create a stronger, more fracture resistant restoration in less time than a traditional layered composite restoration.2 This reduction in chair time will allow your team to schedule more production in your day.   

Incorporating new products and technologies into your practice takes time, but I’m sure you will find, as we did, that it is well worth the process.

1 http://barkerpr.com/2017/08/pulpdent-award-winning-activa-bioactive-restorative-receives-98-rating-at-two-year-recall/

2 http://www.firstimpressionsmag.com/activa-solves-bulk-fill-issues.html

About Karen L Comisi, RDA, CDA, FAADA
Over the past 33 years, Karen Comisi has held almost every staff position in the dental office, with the exception of dentist and dental hygienist. She has been an orthodontic dental assistant, oral surgeon dental assistant, general dentist assistant, front desk and insurance coordinator, office manager, CFO, Co-Founder of Dental Care with a Difference, PC and currently Co-Founder and CFO of Sleep Focused Solutions, Inc.  She is one of the first licensed, registered dental assistants in New York State and is a founding member and Treasurer of the Southern Tier Dental Assistants Society. Karen is a DANB Certified Dental Assistant, a member of the American Dental Assistants Association, the American Association of Dental Office Managers, the Office for Safety & Asepsis Procedures (OSAP), and The American Academy for Oral Systemic Health (AAOSH).

July 11, 2018

3 Reasons to Tell Patients about Bioactive Materials

By Sheri B. Doniger, DDS

As the old adage goes, prevention is the best medicine.

In dentistry, we have been working off of this model for years by teaching our patients about good oral hygiene and home care. Unfortunately, patients are not always compliant. Patients understand they don’t always take proper care of their teeth. They are not always aware of the acidity in foods they eat. Some may not realize the dryness their medication is causing to their oral tissues, since they have been taking that medication for years.

But, patients do understand when you say they need a restoration. Making patients aware of the type of material we use in their mouths is good practice. Here are 3 reasons to tell your patients about bioactive restoratives:

  1. Active Benefits. With bioactive materials, we are utilizing materials that support the natural remineralization process. These materials are not inert. They are constantly exchanging ions to rebuild, rather than just filling a hole.
  2. Added Protection. Bioactive materials help restore damaged tooth structure, creating an environment that will seal, repair and protect the margin of the tooth and the restoration.
  3. Bioactive Prevention. By sealing the margin between the tooth and the restoration, bioactive restoratives help prevent microleakage and its subsequent outcome, recurrent decay.

Once we place a restoration with a bioactive material, it’s important to explain that this material helps rebuild the tooth and is actively working to maintain the tooth structure. This type of education can build trust, case acceptance, and ultimately lead to positive reviews and referrals.

About Dr. Sheri B. Doniger
Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. Her book, “Practical Practice Solutions in Dentistry” focuses on building practice success. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, speaks internationally on a myriad of topics, and writes for several dental publications. She is a past president of the American Association of Women Dentists. You can reach her at donigerdental@aol.com.

 

July 3, 2018

Lime-Lite is Enhanced

Pulpdent Corporation has launched Lime-Lite Enhanced in the USA.

Click here to learn more about Lime-Lite Enhanced

Lime-Lite Enhanced contains an improved, moisture-friendly formula that allows for better adhesion to dentin. The new formula is shock-absorbent and contains no Bisphenol A, no Bis-GMA, and no BPA derivatives.

Handling, delivery and clinical use of Lime-Lite Enhanced is the same as the original product.

Lime-Lite Enhanced is available in a kit with four 1.2mL syringes or in a 3mL syringe. Both configurations come with 20 applicator tips.

June 7, 2018

Bioactive Composites for the Clinician and Patient

Dentist and educator Dr. Robert Lowe has published a new eBook called Bioactive Composites for the Clinician and Patient.

Download Free eBook by Dr. Robert Lowe

Dr. Lowe addresses the importance of patient education, saying that the dentists “have to get better at explaining the disease process of dental caries (decay) and the restorative options that best fit the needs of each patient.”

According to Dr. Lowe, “the majority of today’s dental restoratives are designed merely to occupy space” but bioactive filling materials like ACTIVA BioACTIVE “participate in an ionic exchange of calcium, phosphate, and fluoride that helps neutralize acid attack and supports the natural remineralization process.” Through this ionic exchange, the bioactive material becomes integrated into the tooth and helps create a protective seal.

Dr. Lowe shares best practices on how dentists can discuss treatment options and new technologies like bioactive fillings with their patients.

The eBook features a series of clinical cases, including:

  • Minimally invasive restorations
  • Bulk fillings
  • Root caries restorations
  • Pediatric dentistry
  • Geriatric dentistry

Dr. Lowe provides step-by-step instructions on how to use ACTIVA BioACTIVE-RESTORATIVE in these different clinical situations to ensure better patient outcomes. The cases involve patients of all ages, and Dr. Lowe notes that ACTIVA BioACTIVE addresses many of the challenges associated with both pediatric and geriatric patients. 


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.

June 5, 2018

Heroic Dentistry: Asperger’s Syndrome and Special Care with ACTIVA

By Raymond Kimsey, D.M.D.

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.

Rachel has been diagnosed with Asperger’s Syndrome and was referred to me for comprehensive dental care. She has acute anxiety around dental treatment, which can escalate into a panic attack. We faced the challenge of allaying her fears, keeping her calm, while operating smoothly and uneventfully.

Rachel was experiencing considerable discomfort. Her lower left second molar (#18) had extensive caries and appeared hopeless, but she was still young, and I wanted to try and salvage this tooth for her (Figure 1). Endodontic treatment on her first molar (#19) had been performed successfully at another office, but she had not returned to her dentist to have the tooth restored.

Figure 1. Shows extensive caries in lower left second molar (#18).

I would have to complete this case in one visit. Proper isolation would be imperative. My treatment plan was to excavate the second molar (Figure 2), isolate the area, quickly build up the entire distal-lingual wall, and proceed with root canal treatment. The wall would allow me to place a rubber dam with a good seal, contain the irrigating fluids within the confines of the tooth, and then use the wall as part of the final restoration.

Figure 2. Second molar after caries removal.

Controlling hemorrhaging from the gingiva is critical for these procedures. Placement of retraction cord treated (Figure 3) with ferric sulfate can stop bleeding, but the challenge is to prevent contamination and bleeding when building up the wall. For this reason, I selected ACTIVA Bioactive-Restorative. It is easy to control the flow and placement of ACTIVA through the bendable metal cannula, and this technique eliminates the use of hand instruments that could disturb the gingiva and cause bleeding.

Figure 3. Shows retraction cord in place.

I placed a thick layer of Teflon tape over the pulpal floor to facilitate access to the pulp chamber (Figure 4), and I built up the distal-lingual wall with ACTIVA (Figure 5). I could now place a well-sealed rubber dam and perform endodontic treatment on #18 (figure 6). After debriding the pulp (Figure 7) and obturating the canals (Figure 8), I completed the restoration with ACTIVA (Figure 9).

Figure 4. Teflon covers pulpal floor before building up distal-lingual wall.

Figure 5. Distal-lingual wall built up and margins sealed with ACTIVA.

Figure 6. Shows pulpal access, ACTIVA walls, and rubber dam in place.

Figure 7. After debriding pulp.

Figure 8. Canals are obturated.

Figure 9. Final ACTIVA restoration.

Using ACTIVA I could accomplish all this in one appointment with a material that provides an excellent foundation for a future crown and will be more resistant to recurrent caries at the margins.


About Dr. Raymond Kimsey
Dr. Kimsey is in private practice in Coral Gables, Florida. His specialties include implantology, anesthesia and IV sedation, and management of patients with mental and physical developmental defects.

May 22, 2018

Embracing Mission Experiences with Embrace Sealant Material

by Sherri M Lukes, RDH, MS, FAADH

The villages throughout the desert country of central Mexico are populated by poor villagers with little to no access to dental services. As a dental hygienist/university professor with a passion for mission work, I have had the privilege of serving annually on a team in this area for the past 15 years. Accompanied by eager dental hygiene students we descend on the area for a week, travelling to a different village each day, lugging portable equipment and supplies to provide preventive services from sun up to sun down.

Though an area entrenched with poverty, the children have no shortage of sugary foods and beverages. One child will present with marked dental fluorosis due to naturally occurring fluoride in the water supply while the next child will present with rampant decay, illustrating the multifactorial nature of dental caries. A substantial portion of the services provided each year include placing sealants on any of the children’s permanent teeth that haven’t already been affected by decay.  Dental sealant placement, however, is a very technique sensitive procedure, necessitating a dry field for optimal retention. Indeed, moisture contamination is the most common cause of sealant failure.1 In this setting, not only are we working with anxious and “wiggly” children, the conditions are less than optimal for maintaining a dry field to place sealants. In addition, the dental hygiene students involved in the mission are still learning themselves, and not as adept as experienced clinicians.

The aforementioned issues have made Embrace sealant material a staple supply for every trip we’ve taken over the past several years. The first of its kind, this pit and fissure sealant material bonds to moist tooth surfaces, eliminating the need for an absolute dry field. Research on the product has shown remarkable sealing ability and adaptation to tooth structure.2,3

I specifically remember one of many days that were met with equipment malfunction during the mission trips. On this particular day the air/water syringe on one of the portable units was not sealed properly and the air flow contained a small amount of water when the stream of air was released from the syringe. Had we not been using a moisture tolerant material, we would have had no way to adequately place sealants on the endless lines of children waiting to be treated that day.  What a great product solution for such conditions! I came back to the states and told the Pulpdent representative who served our institution that I would take nothing but Embrace sealant material on subsequent trips.

Any dental professional who has ever practiced in an alternative setting realizes the challenges associated with providing care without the amenities of a fully equipped dental operatory. Mission opportunities are such settings and can test the skills of even the best of practitioners. I am thankful for innovative products that enable me to follow my passion with the assurance that the service I am providing is going to be a lasting benefit to the patients’ oral health.

References
1. Feigal, Robert J. “Sealants and preventive restorations: review of effectiveness and clinical changes for improvement.” Pediatric Dentistry 1998;20: 85-92.
2. Kane B, Karren J, Garcia-Godoy C, Garcia-Godoy F. “Sealant adaptation and penetration into occlusal fissures”. American Journal of Dentistry 2009;22(2):89-91.
3. Strassler HE, O’Donnell JP. “A unique moisture-tolerant, resin-based pit and fissure sealant: clinical technique and research results”. Inside Dentistry 2008;4(9):108-110

About Sherri M Lukes, RDH, MS, FAADH
Speaker, 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 smlukes@siu.edu.