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Enamel Pro: Stimulates Remineralization?

I have quite a number of younger patients receiving orthodontic therapy. They come in for their routine oral prophylaxis. I am wondering about having my hygienists use Enamel Pro [Premier] for their prophylaxis paste. It has ACP [amorphous calcium phosphate] which should stimulate remineralization, especially around the bracket edges. As well, it should reduce caries. I am thinking this is just another way to help prevent any problems while they are in ortho. Any thoughts on this?

Editor´s Note:
Enamel Pro, from Premier, is the only prophy paste with ACP (Amorphous Calcium Phosphate). Enamel Pro creates ACP when it contacts the patient’s teeth and saliva. As ACP forms it is incorporated within the enamel surface where it remains after rinsing. The available ACP helps prevent future damage by stimulating re-mineralization of the tooth enamel. ACP fills in surface enamel crevices for an intense polish and shine.

RelyX Luting Plus: Better Alternative for Ceramic Restorations?

I have been using RelyX Unicem [3M ESPE] for about 2 years with great success. I have absolutely no complaints. Easy to use and works great. But I have heard that resin modified glass ionomer cements have fluoride release that prevents caries. There is also RelyX Luting Plus which is sort of the resin modified glass ionomer version of RelyX Unicem. Also this kind of fluoride recharges over time so that the fluoride release continues. My concern is that I want a cement that I can use for both PFMs and ceramic restorations. Can I use a resin modified glass ionomer to cement ceramic restorations? If so, what are your thoughts on RelyX? Is this the best one on the market or are there better alternatives?

Editor´s Note:

According to 3M: “RelyX Luting Plus is an advanced paste-paste, resin-modified glass ionomer formula in the convenient Clicker™ Dispenser. Strong mechanical properties and easy handling make it the perfect choice for cementing routine restorations.

Benefits include:

Easy to mix, load and seat

Consistent mix ratios

Enhanced marginal integrity with low solubility

High fracture toughness

Sustained fluoride release

Virtually no post operative sensitivity

Curing Light for Dental Fillings May Stunt Tumor Growth

A blue curing light used to harden dental fillings also may stunt tumor growth, Medical College of Georgia researchers say.

“The light sends wavelengths of blue-violet light to the composite, which triggers hardening,” says Alpesh Patel, a rising MCG School of Dentistry junior. “The light waves produce free radicals that activate the catalyst and speed up polymerization of the composite resin. In oral cancer cells, though, those radicals cause damage that decreases cell growth and increases cell death.”

Mr. Patel, who has been working with Dr. Jill Lewis, associate professor of oral biology, Dr. Regina Messer, associate professor of oral rehabilitation and oral biology, and Dr. John Wataha, adjunct professor of oral rehabilitation and oral biology, studied 10 tumor-bearing mice, five treated with the light and five untreated.

He exposed half the mice to the blue light for 90 seconds a day for 12 days. Then the tumors were extracted and each one was split into two sections. Half were used to create slides for tissue analysis, and half were frozen to prepare protein extracts.

Tissue analysis indicated an approximate 10 percent increase in cell suicide, or apoptosis, in the light-treated tumors. The frozen protein extracts revealed a nearly 80 percent decrease in cell growth in the light-treated tumors.

“The decrease in cell growth, combined with increased apoptosis, helps explain why the tumors didn’t grow as much because you have cells that aren’t dividing and you have cells that are committing suicide,” Mr. Patel says.

Dr. Lewis predicts treating the tumors with blue light sooner will increase the rate of apoptosis, possibly preventing the tumor from ever becoming measurable and easing treatment.

“One desirable feature we’ve observed with the blue light is that non-cancerous cells appear unaffected at light doses that kill tumor cells,” says Dr. Lewis. “We’re thinking that some day, blue light therapy may serve as an adjunct to conventional cancer therapy. Patients may, therefore, receive lower doses of chemotherapy, which would decrease the adverse effects most cancer patients experience from standard chemotherapy regimens.”

Source:
Amy Connell
706-721-8605
Medical College of Georgia

Researchers Use a Patient’s Own Bone to Accelerate Orthodontics

Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as “Wilckodontics.”

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.

As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.

Nowzari says that his team believed they could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explains. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

Source:
Angelica Urquijo
213-740-6568
University of Southern California

Silent Nite: Treatment for Snoring?

I am reading more and more about Sleep Dentistry and Obstructive Sleep Apnea. Some of my patients who snore have started to ask me about wearing an appliance or having surgery to cut down on their snoring.

I have seen many advertisements for training courses and products in this area and I see that this is becoming a growth area in dentistry. But I am worried about masking significant signs and symptoms by making a snoring appliance. I believe that Silent Nite [Glidewell Labs] is the most widely used appliance for snoring. What are other dentists doing about this area? Do you send the patient to a physician to be evaluated or do you do you own evaluation? How difficult is it to adjust the Silent Nite appliance? Has it helped your patients?

Editor´s Note:
According to Glidewell Labs:
”

Relaxed and collapsed airway produces soft tissue vibrations during breathing that result in snoring. The Silent Nite device positions your lower jaw forward, keeping your airway open, allowing easier breathing and preventing snoring. The special connectors allow your lower jaw to move freely providing maximum comfort during sleep.

Snoring research has also shown that custom fabricated dental devices worn at night that
move the lower jaw into a forward position, increase the three dimensional space in the airway
tube which reduces air velocity and soft tissue vibration. By increasing the volumetric
capacity of the airway and preventing soft tissue vibrations, snoring is eliminated. In clinical
research studies, these dentist prescribed oral devices have exhibited initial snoring prevention
success rates of between 70 to 100%.

The SILENT NITE device positions the lower jaw into a forward position by means of special
connectors that are attached to transparent flexible upper & lower forms. The forms
are custom laminated with heat and pressure to the dentist’s model of the mouth.The fit is
excellent and comfortable. “

Guayule Latex Gloves: Have You Made the Switch?

I have a number of patients in my practice who are allergic to rubber latex. Because of this I have completely switched over to gloves that do not contain any latex rubber. I read in the news that there is a new material out called guayule which is very similar to latex rubber but does not produce an allergic response. For those of you already using gloves made out of this material, what are you thoughts? Have you started using it?

Editor’s Note:

In April 2008, the FDA cleared for marketing the first device made from a new form of natural rubber latex, guayule latex. The product, the Yulex Patient Examination Glove, is derived from the guayule bush, a desert plant native to the Southwestern United States.

Traditional latex gloves are made from the milky sap of a rubber tree, Hevea braziliensis. The sap contains a protein that may trigger allergic reactions, especially after prolonged and repeated contact.

Estimates vary, but anywhere from 3 percent to 22 percent of all health care workers are sensitized to traditional latex. Available data on the new guayule latex show that even people who are highly allergic to traditional latex do not react on first exposure to guayule latex proteins.

“This approval has the potential to make a significant difference to both the general public and the medical community at large,” said Daniel Schultz, M.D., director of FDA’s Center for Devices and Radiological Health. “Gloves made from guayule latex may prove to be a safer alternative for some people with sensitivity to traditional latex. And yet they will not sacrifice the desirable properties of traditional latex such as flexibility and strength.”

The Yulex glove is made by the Yulex Corporation of Maricopa, Ariz.

Source: www.fda.gov

DAMit Membrane Kit: Reduce Gagging?

At the Chicago Midwinter I tried out this material for keeping impression material from going on down the patient’s throat. It’s called DAMit! from Danville. It is like a piece of tape that you can stick to the back of the maxillary tray. It is soft enough to conform to the palate, but strong enough to hold the material back from going to far down the patient’s throat. It looks real good and makes sense. Anybody using it?

Editor’s Note:
According to marketing material:

“DAMit! can help reduce gagging and ensure capturing of second and third molars in impressions with DAMit! Posterior Dam and Periphery Extension Membrane. The easy-to-apply, self-adhesive membrane creates a flexible barrier that maintains hydraulic pressure against the distal of back molars and helps prevent material from running down the patient’s throat.

To use, simply pull a strip of DAMit! from the convenient dispenser, and attach it to the back of either a metal or plastic tray. Fill the tray and place it as normal. The membrane actually incorporates into the impression material, and can even become folded into a margin without creating a distortion. Ideal for all techniques, viscosities and types of impression materials.”

SPRITE CT System: Simplified CT?

IMTEC Corporation proudly presents the SPRITE, a revolutionary new low cost, small footprint CT system. Designed with a new level of ease of use and scanning speed, the SPRITE joins IMTEC’s line of industry leading industrial scanning systems.

“IMTEC has greatly simplified CT with the introduction of the SPRITE,” said IMTEC President and CEO Tim Thompson. “With this new user-friendly machine, CT is now practical for users of all levels of experience.”

The system uses state-of-the art touchscreen technology as its User Interface, and an advanced 4-stage rotary system to simplify and ensure successful scanning setup and execution. “The SPRITE system represents a revolution in Computed Tomography. It brings many new innovations to market all in one package — low cost, convenient size and automated scanning.
SPRITE will vastly expand the 3D scanning market,” said Tom Nora, IMTEC Product Manager for CT Technologies.

Drawing on this experience and expertise, IMTEC has created a simple system that retains all of the features associated with IMTEC’s Industrial FlashCT(R) product line. The result is a system that can be used with minimal training and setup, allowing the user to begin scanning immediately. Using the SPRITE is as simple as placing a sample on the stage, closing the door and pressing
“SCAN.”

The SPRITE also has other convenient features: rollers for ease of movement and dimensions small enough to allow passage through any conventional doorway. With the SPRITE, IMTEC continues to realize its long term strategy of incorporating FlashCT(R) imaging technology in areas not previously associated with industrial and healthcare 3D imaging.

Source: IMTEC Corporation

Saving Teeth by using Periodontal Ligament Regeneration

Teeth may fall out as a result of inflammation and subsequent destruction of the tissues supporting the teeth. Dutch researcher Agnes Berendsen has investigated a possible solution to this problem. At the Academic Centre for Dentistry Amsterdam (ACTA), she has studied the regeneration of the periodontal ligament by use of tissue engineering. The 3D in vitro model she has developed appears to be promising for regenerating periodontal ligament and may also prove valuable for restoring tendons and ligaments elsewhere in the body.

The periodontal ligament forms a flexible connection between the tooth root and the surrounding jaw bone. Trauma or inflammation can cause destruction of the periodontal ligament. Berendsen chose tissue engineering to tackle this problem. Research in tissue engineering uses cells placed in a 3D model, after which signals are applied to activate the cells. Berendsen developed a new 3D model in which cells isolated from periodontal ligament were implanted in a collagen network suspended between an artificial root and artificial bone. She wanted to see if viable periodontal ligament could be generated in this way.

The composition of the collagen network in which the cells are located has a considerable influence on the contractile properties of the cells. Contraction of the cells creates internal tension in the network which keeps the cells active. The network must be well attached to the surrounding solid surfaces to prevent its detachment. Berendsen managed to attach the network to these artificial root and bone surfaces present in the model by creating an enzyme-mediated mineral deposition on the surfaces. By subsequently applying loading to the tooth root (mimicking the process of chewing) in the 3D model, she was able to deform the mineral-anchored network containing the cells. The subsequent response of the cells was dependent on the magnitude of the loading.

Follow-up research will investigate whether the cell-culture results can be translated to an animal model to obtain more accurate insights concerning the potential use of this method in humans.

Source:
Contact: Agnes Berendsen
31-204-448-663
Netherlands Organization for Scientific Research

Filtek LS: Lowest Polymerization Shrinkage?

Dr. I. asks:
My understanding of composite chemistry is that every composite shrinks when it is light cured. I read an advertisement that Filtek LS [3M ESPE] has less than 1% polymerization shrinkage which is the lowest of all the composites. I do not know anything about its aesthetics so I do not know how it competes in this way with the other composites on the market. Is there good research to back up this claim of lowest polymerization shrinkage? Does this really make that much difference? Has anybody actually tried this and do you see a difference?

Editor’s Note:
According to 3M:

“Any time you restore a patient’s tooth, you strive to achieve a “perfect margin” – a smooth connection between the tooth structure and restoration without interruptions or gaps. Even if your technique is perfect, achieving lasting marginal integrity is a challenge because all composites shrink.

Shrinkage is intrinsic to resin chemistry – which is why, to date, no methacrylate-based composite has solved the shrinkage problem.

The Filtek LS Low Shrink Posterior Restorative System is based on 3M ESPE’s latest product innovation: silorane chemistry. This scientific breakthrough results in the lowest volumetric shrinkage to date. The silorane-based composite works with a dedicated self-etch adhesive.

Dedicated adhesive provides excellent bond strength.

The Filtek LS Low Shrink Posterior Restorative System combines the lowest-shrinking silorane-based composite with a dedicated two-step, self-etching bonding system:

3M™ ESPE™ LS System Adhesive Self-Etch Primer and Bond. It offers excellent bond strength to enamel and dentin, and is the one and only adhesive formulated to provide optimal bonding with such an extraordinarily low-shrinking composite.”

Radica: A More Efficient System for Provisional and Diagnostic Restorations?

At a dental meeting I recently had the opportunity to try out the new light cured temporary crown and bridge material Radica, from Dentsply. The temporary bridges looked great and appeared to be very strong. According to the rep from Dentsply, Radica is much stronger than most other comparable materials and is better for long term temporary bridge usage. The only downside was that it takes 30 minutes to fully cure Radica in a Triad oven – if I understood the rep. I’m wondering what others experience has been with Radica and if it and how it has proven beneficial for practice?

Editor’s Note:
According to Dentsply:

“The provisional restoration plays an important role in maintaining the esthetic and functional aspects of a patient’s dental health, and has a significant impact on the final restoration placement as well. Provisional restorations are also being used for longer service terms, as the use of implant therapy becomes more popular. Current options, direct and indirect, suffer from material and process limitations, giving rise to concerns about wear in service, durability, load-bearing capability, or esthetics.

Radica is a new system for provisional and diagnostic restorations from DENTSPLY Ceramco. Based on a visible light curing (VLC) composite platform, Radica has been developed to exceed the performance criteria of currently available restorations.

The use of a composite material as a provisional is not novel in and of itself. However, the process to fabricate these is cumbersome, and involves layering build-ups 9-1 1. The Radica system offers a unique solution by using a shape stable visible light
cured composite material as a basis…Radica provides enhanced strength, durability, and wear resistance, with a significant improvement in esthetics over current provisionals. The capability to efficiently layer enamel and dentin materials, in combination with characterization, provides for excellent patient satisfaction when serving as both a diagnostic and a provisional restoration.

Additional Benefits of Radica include:
*Provides a Life-Like tooth-colored diagnostic for case presentation
*Offers the optimum in a low-wear, highly durable material for long-term provisional restorations
*Delivers premium high-end esthetics to your patients as they transition to their fixed restoration
*Yields excellent strength for confidence in performance

The Provisional Process with Radica

To receive a customized provisional restoration, practitioners forward impressions of unprepared teeth to a trained dental laboratory, using VPS materials such as Aquasil Ultra Smart Wetting Impression Material. After preparing a model from this impression (Step 1), the laboratory may create a matrix out of quick-setting silicone. Next, warmed Radica enamel resin is extruded into the incisal area. Warmed Radica dentin is then extruded into the dentin area of the matrix (Step 2). The
matrix is now adapted to the model. The shape-stable Radica resin cools into the exact contours determined by the lab ( Step 3). This resin may be added to, adapted, tried in or easily modified in its wax-like uncured state (Step 4). The resin is light and heat-cured with a glaze-like sealer in a variety of processing units: the Eclipse®, the Enterra™ or the Triad® VLC Light Curing Units. The restoration may be characterized using effect dentins and stains. The laboratory delivers the finished provisional to the dentist.”

More information is available at: www.ceramco.com

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