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KromaFaze: A Better Alginate Impression System?

Every dental office makes alginate impressions. I have been considering changing over to KromaFaze (Dux Dental) for simplicity. You have one package that has the alginate on one end and the water on the other end. Just tear open and mix.

I cannot count the number of times that we get ready to make an alginate impression and we have to go to another room to get an alginate scoop or a water measuring gauge. If you use more than one alginate system in an office, it gets even more confusing.

It will probably cost more to stock KromaFaze but in the long run may save me more chair time. Also the KromaFaze changes color when it has set and so we do not have to worry about timing the setting reaction. Anybody using this ? Am I right to switch to this?

MI Paste: How Does This Compare to Pronamel?

Dr. L. asks:

I have a lot of younger patients in treatment and I would like to think that I am doing the best in the way of preventive dentistry for them. So, I’m wondering which is a better product for a general practice, Pronamel (Glaxo) or MI Paste (RECALDENT)?

They both promote remineralization. But MI Paste appears to have a unique technology in its CPP-ACP (1). Pronamel has a neutral pH and very low abrasion of enamel. It also has potassium nitrate to reduce tooth sensitivity. Which product of this group are you using in your practice and why? What are your thoughts on their supposed unique ingredients?

Editor’s Note:
According to RECALDENT MI Paste contains: CPP-ACP.

“Casein Phosphopeptide (CPP) are natural occurring molecules which are able to bind calcium and phosphate ions and stabilize Amorphous Calcium Phosphate (ACP). It adheres easily to soft tissue, pellicle, plaque and even hydroxyapatite. Reacts similar to the mineral/statherin relation in saliva supplying bio-available calcium and phosphate required for remineralization to take place. Under acidic conditions, RECALDENT™ (CPP-ACP) releases calcium and phosphate ions into tooth enamel.”

Arestin: Will This Cut Down on Referrals?

Dr. L. asks:
I know Arestin (Orapharma) has been around for a long time. I have been using a protocol of scaling and root planning and improved oral hygiene and my impression is that this has worked well in my practice. My periodontist has been using Arestin therapy with great success in treating acute periodontal abscesses. I have referred over patients with this and all he usually does is inject some Arestin into the abscess. He claims that in many cases, this is all that is needed for treatment to reduce the acute symptoms. If this is true, then I might as well start injecting the Arestin in my office and skip the referral. What are your thoughts on this?

Cutting Thru Metal Frameworks on Bridge?

Anon. asks:

Today I had to cut off a 3-unit bridge made of base metal alloy. The metal framework was very thick. I tried coarse diamonds first which did not get me anywhere. I then tried out a new product called metal cutters from Microcopy. They are supposed to make it easy to cut through metal – hence the name metal cutters. These burs chattered and bounced off the metal. They broke almost as frequently as the 556 cross-cut fissure burs that I tried. Please, if anybody knows of any product that will allow me to cut through these metal frameworks – what is it?

Stylus ATC Handpiece: Better Than Standard Air Driven Handpieces?

Midwest has just come out with a new hybrid high-speed handpiece called the Stylus ATC. It is supposed to run partly on air and partly on electric. Midwest claims it cuts with greater power and more accuracy then comparable handpieces. Is anybody using this? How would you rate this handpiece? Is it that much better than standard air driven high speed handpieces? Are these handpieces sturdy? I know we can drop our air driven high speed handpieces and they still work just fine. I have been considering switching to electric handpieces. I have tried them out at the dental meetings. They cut great. But the start-up costs concern me. Any thoughts?

According to Midwest:

“For the first time ever, air & electric handpieces have fused into a single handpiece system to deliver the power and efficiency of an electric without sacrificing the superior access lightweight and familiar comfort of an air handpiece.

* With activation of the rheostat, the Stylus ATC system:
o Accelerates to an optimal cutting speed.
o Continually monitors bur load.
o Senses the amount of torque delivered.
o Automatically adjusts torque to maintain peak power.
o Limits speed when the bur is not under load to minimize wear on handpiece bearings.
“

iBond Self Etch: The Ideal Bonding Agent?

I would like to use just one bonding system for all my bonding needs. My assistants have great difficulty in learning the steps of different bonding systems and I want to make it easier for them. I also only want to have to keep inventory for one system and not have to worry about multiple bonding systems. I have been seeing advertisements for iBond [Heraeus] and I think this may be the answer. It is a one-bottle system. With one application iBond Self Etch, you get etching, priming, wetting and bonding. Sounds really good. What is your experience with this product? Does it have good bond strength?

According to Heraeus:

“iBOND Self Etch, is the 7th generation all-in-one bonding agent that etches, primes, bonds, and desensitizes in one single step. With numerous scientific studies and based on Heraeus Kulzer’s long term bonding expertise, iBOND Self Etch combines high bond strength, improved marginal sealing, and virtually no post-operative sensitivity with an easy, fast and more convenient application.

iBOND Self Etch is indicated for:

* Bonding of direct composite restorations.
* Bonding of indirect restorations in combination with light-curing luting cements.
* Sealing of hypersensitive areas of teeth.”

New molecular tag IDs bone and tooth minerals

Enlisting an army of plant viruses to their cause, materials researchers at the National Institute of Standards and Technology (NIST) have identified a small biomolecule that binds specifically to one of the key crystal structures of the body—the calcium compound that is the basic building block of teeth and bone. With refinements, the researchers say, the new molecule can be a highly discriminating probe for a wide range of diagnostic and therapeutic applications related to bones and teeth.

Although, they have somewhat different mechanical properties, the major structural component of both teeth and bones is a crystalline compound of calcium phosphate called hydroxyapatite. Subtle variations in the way the crystal forms account for the differences. Identifying and monitoring the formation of this particular crystal is of paramount importance to biomedical researchers working on a variety of problems including the remineralization of teeth to repair decay damage, the integration of prosthetic joints and tissue-engineered bone materials for joint and bone replacement, and cell-based therapies to regrow bone tissue.

To date, however, there is no specific, practical method to spot the formation of hydroxyapatite in living systems or tissue samples. Materials scientists can identify the crystal structure with high reliability by the pattern it makes scattering X rays, but it’s a complex procedure, requires fairly pure samples and certainly can’t be used on living systems. There are some widely used chemical assays—the von Kossa assay, for example—but these also are destructive tests, and more importantly they really test simply for the presence of the elements calcium or phosphorus. They can’t distinguish, for example, between deposits of amorphous calcium phosphate—a precursor—and the hydroxyapatite crystal.

To find a more specific, less destructive probe, the NIST team used a relatively new technique called “phage display” that can rapidly create and screen huge numbers of biomolecules for specific interactions. Phages are a primitive and ubiquitous class of viruses that infect bacteria. Some simple phages can be genetically modified to randomly assemble short sequences of amino acids—small proteins called peptides—on their outer shells as binding sites. An engineered population of phages will synthesize billions of random peptides. If these phages are exposed to the target surface—hydroxyapatite crystal in this case—and then washed off, those left behind are the ones that tend to stick. Cloning the survivors and repeating in several cycles with increasingly stringent conditions eventually isolates a handful of candidate peptides that can be further tested to measure their affinity for the target.

As reported in a recent paper,* the NIST team used the technique to identify a new peptide that relies both on the chemical composition and the crystal structure of hydroxyapatite to bind to the mineral’s surface. The peptide’s ability to “recognize” the specific structure of hydroxapatite, say the researchers, could be exploited as a nondestructive tag to monitor the progress of bone and tooth mineralization for diagnostic and therapeutic applications.

###
Source:
Contact: Michael Baum
301-975-2763
National Institute of Standards and Technology (NIST)

* M.D. Roy, S.K. Stanley, E. J. Amis and M.L. Becker. Identification of a highly specific hydroxyapatite-binding peptide using phage display. Adv. Mater. 2008, 20, 1830-1836

First Quarter Impression Material: Fastest of Vinyl Polysiloxane Impression Materials?

I work very fast in my operatory. I can prep a tooth for a crown in about 4 minutes. But it often takes me at least 20 minutes to make an impression. I find even with cord, lasers, electrosurgery or other tissue retraction products and hemostatic agents, there is too much time spent making an impression. I have been researching setting times of vinyl polysiloxane impression materials and I think that Danville Engineering line of First Quarter impression materials have the fastest setting time – 1 minute 45 seconds – from mi to complete intraoral set. Before I invest in these materials, I would like to get some feedback from regular users. What are you thoughts on the vinyl polysiloxane impression materials, and specifically First Quarter?

Ultra-Etch: The Gold Standard for Phosphoric Acid Etchant?

I know this is not high-tech breaking news, but I saw an advertisement for Ultradent claims that their 35% phosphoric acid is the ‘Gold Standard’ for phosphoric acid etchant.

I consider phosphoric acid to be a very minor expense but a very important component of my resin bonding systems. I use mostly Total Etch bonding. Can there be any truth to their claim that their phosphoric acid etchant is the best? I would be quite happy to buy this product if their claim is true. What are your thoughts?

Editor’s Note:

According to Ultradent:
“Ultra-Etch viscous solution (35% phosphoric acid) has been specifically designed to render
an optimum level of viscosity. Ultra-Etch is self-limiting in its depth of etch (average depth
of 1.5µm with 15 second etch). Ultra-Etch will flow into precise locations with the Inspiral
Brush or Blue Micro tip (even into occlusal grooves for sealant preparation). They are just
viscous enough to prevent migration caused by gravity and also maintain a thick enough
layer to prevent premature drying. These etchants contain no glycerin and are designed for
rapid and complete removal upon rinsing.

The ideal viscosity combined with the versatility of the Inspiral Brush tip or Blue Micro tip
allow placement of the etchant in any location, including lingual approaches to Class lll
restorations. Ultra-Etch works nicely for etching before bonding composites, sealants, or
bonding adhesives. The tips are disposable, helping to prevent cross-contamination”

Novel Hydrogel Systems for Dentin Regeneration

Dental caries, or tooth decay, continues to be the most prevalent infectious disease in the world, presenting significant public health challenges and socio-economic consequences. It leads to the loss of the hard tissues of the tooth, followed by inflammation and necrosis of the subjacent dental pulp.

In the U.S. alone, over 20 million dental restorations are placed each year, with failure rates of up to 60%. Hence, there exists a critical need for better biologic therapeutics to restore the damaged dentin-pulp complex to its original form and function. However, progress in this area has been slow compared with that in other fields of regenerative medicine.

Tissue-engineering strategies directed at mimicking the natural extracellular matrix have utilized synthetic and non-synthetic scaffolds to direct cell differentiation and matrix mineralization (in the case of bone). The most promising among the new generation of delivery systems are synthetic peptide hydrogels, which provide a nanostructured matrix highly similar to natural matrix. Short peptides can be designed to self-assemble into nanofibers, form macroscopic gels, and entrap living cells. With single amino acids as building blocks, the resulting materials are non-toxic, non-inflammatory, and biodegradable. The modular concept allows for high control over the system and, at the same time, makes it extremely versatile.

Speaking during the 86th General Session of the International Association for Dental Research, a team of investigators from Baylor College of Dentistry (Dallas), the University of Regensburg (Germany), and Rice University (Houston) presented its preliminary data describing the results of studies on hydrogels made of peptide amphiphiles, where a short peptide sequence is attached to a fatty acid, which provides the driving force for self-assembly. However, they recently applied a different design concept, where the self-assembly of peptide chains is achieved without attaching a hydrophobic tail. Based on their design, the chains can include bioactive peptide sequences for cell adhesion, binding of growth factors, or other biological molecules with therapeutic potential. Hence, multidomain peptide hydrogels represent a novel and highly versatile material offering a higher degree of control over nanofiber architecture and better chemical functionality.

The overarching goal of this research is to utilize these multidomain peptides as a biomimetic scaffold, along with dental stem cell therapy, to provide a natural 3D environment that can control and direct the differentiation and function of dental stem cells for the targeted regeneration of the dentin-pulp complex.

This work is highly translational and innovative, since it capitalizes on a new and previously untested material with novel properties for the regeneration of the dentin-pulp complex. Importantly, the results will provide the foundation for developing multidomain peptide scaffolds as novel therapeutics for the regeneration of the dentin-pulp complex.

###

About the International Association for Dental Research

The International Association for Dental Research (IADR) is a non-profit organization with more than 10,800 individual members worldwide, dedicated to: (1) advancing research and increasing knowledge to improve oral health, (2) supporting the oral health research community, and (3) facilitating the communication and application of research findings for the improvement of oral health worldwide.

To learn more about the IADR, visit www.iadr.org.

This is a summary of an abstract entitled “Novel Hydrogel Systems for Dentin Regeneration”, by R.N. D’Souza et al., of the Baylor College of Dentistry (Dallas), to be presented at 3:30 p.m. on Friday, July 4, 2008, in Hall D-E of the Metro Toronto Convention Centre, Toronto, ON, Canada, during the 86th General Session of the International Association for Dental Research.

Xylitol a Topical oral syrup prevents early childhood caries

Dental researchers at the University of Washington have reported a significant reduction of tooth decay in toddlers who were treated with the topical syrup xylitol, a naturally occurring non-cavity-causing sweetener. Their results were presented today during the 86th General Session of the International Association for Dental Research.

In a recent clinical trial in the Republic of the Marshall Islands, children 6 to 15 months old were given oral doses of xylitol in fruit-flavored syrup daily to determine whether the substance can prevent early-childhood tooth decay, or “caries”.

Researchers reported that nearly 76% of the children in the group who received xylitol were free of tooth decay by the end of the study, compared with 48% of the children in the group that did not receive the substance.

The Marshall Islands in the Pacific were chosen for the study because it is an area where childhood tooth decay is a serious public health problem. The average child entering Head Start at age 5 has 6.8 cavities—two to three times the rate in a typical mainland community. Researchers came from the Northwest/Alaska Center to Reduce Oral Health Disparities and the Department of Dental Public Health Sciences at the University of Washington, Seattle.

Xylitol can be administered in the form of chewing gum, lozenges, or syrup. The U.S. Food and Drug Administration has approved xylitol’s use in food since 1963 and classifies the substance as safe.

According to researchers, at the end of the trial nearly 76% of the children in the study group were caries-free, compared with 48% in a comparable group that did not receive treatment.

Xylitol is a five-carbon sugar alcohol that is used as a sugar substitute.

###

Funding was provided by HRSA Maternal and Child Health Bureau and the National Institute of Dental and Craniofacial Research.

About the International Association for Dental Research

The International Association for Dental Research (IADR) is a non-profit organization with more than 10,800 individual members worldwide, dedicated to: (1) advancing research and increasing knowledge to improve oral health, (2) supporting the oral health research community, and (3) facilitating the communication and application of research findings for the improvement of oral health worldwide.

To learn more about the IADR, visit www.iadr.org.

This is a summary of an abstract entitled “Xylitol Topical Oral Syrup Prevents Early Childhood Caries: a RCT”, by P. Milgrom et al., of the University of Washington, Seattle, and the Ministry of Health, Marshall Islands, to be presented at 1:45 p.m. on Saturday, July 5, 2008, in Hall D-E of the Metro Toronto Convention Centre, Toronto, ON, Canada, during the 86th General Session of the International Association for Dental Research.

Early Detection of Oral Cancer: Is Velscope Reliable?

I have taken 2 courses in the early detection of oral cancer. In one of these courses, the lecturer made a strong case for using the VELscope to detect oral cancer at such an early stage that no other signs were apparent, other than the characteristic appearance under the VELscope. He presented numerous cases of early detection confirmed by biopsy. In another course, taught by an oral surgeon, the emphasis was on visual inspection and referral for biopsy when needed. He felt the VELscope was not reliable. What is the experience of the readers who are VELscope users? What about other technologies, such as OralCDx, for the early detection of oral cancer? Are these technologies reliable and useful? Thanks.

Editor’s Note:
According to the VELscope:

“VELscope is a revolutionary hand-held device that provides dentists and hygienists with an easy-to-use adjunctive mucosal examination system for the early detection of abnormal tissue. It is based on the direct visualization of tissue fluorescence and the changes in fluorescence that occur when abnormalities are present.

The VELscope Handpiece emits a safe blue light into the oral cavity, which excites the tissue from the surface of the epithelium through to the basement membrane (where premalignant changes typically start) and into the stroma beneath, causing it to fluoresce. The clinician is then able to immediately view the different fluorescence responses to help differentiate between normal and abnormal tissue. In fact, VELscope is the only non-invasive adjunctive device clinically proven to help discover occult oral disease.”

Sapphire Home Whitening: No Hypersensitivity?

I have seen the advertisements for Sapphire, the new at-home bleaching kit from DenMat. They claim that all the patient needs to do is bleach for 3 minutes a day for 2 weeks and they will have a whitened smile. They also claim no hypersensitivity afterwards. Have any of you tried this with your patients? Does this really work so well? Are there any downsides to this?

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