Issuu

D E N TA L S O L U T I O N S

NOV / DEC 2021

DIGITAL SOLUTIONS

6 - 13

47 - 59

40 - 45

AUSTRALIA’S LARGEST ONLINE STORE FOR DENTAL PROFESSIONALS ONLINE

TAKE ADVANTAGE OF THESE EXCLUSIVE BENEFITS

WHITENING SOLUTIONS

ENDODONTIC SOLUTIONS

INFECTION CONTROL SOLUTIONS

•

Speed up your consumable ordering

•

Select from over 30,000 products

•

Track & Trace deliveries

•

Ordering templates to save time & money

•

View your backorder status

•

Pay your account quickly Online

•

Inventory Management Solutions

• Online Live Chat - to resolve any questions

HENRY SCHEIN.COM.AU Our Solutions

Our Brands 16-35

3Shape 68-69

Kavo 66-67

68-69, 87

Ansell 56-57

Komet

44, 80-83

Endodontic Solutions

40-45

AquaCare 28

Kuraray Noritake

20-27, 76

•

Webinars

Equipment Solutions

64-67

BL 84

Mocom 47

•

Podcast

Handpiece Solutions

62-63

Colgate 6

Morita

Infection Control Solutions

47-59

•

Clinical Videos

Coltene

29-35, 45, 54-55

Planmeca 64-65

Instrument Solutions

60-61

Dentisan 49

Renfert 70-71

•

Henry Schein TV

Durr Dental

Scheu 13

•

Clinical Articles & News

•

Latest In-Person Events & Courses

Cosmetic & Restorative Digital Solutions

New Products Solutions 4-5, 75-86 Pain Control

36-37

Paediatrics Solutions

38-39

Practice Management Solutions 46 Preventative Solutions

14-15

Prosthetic Solutions

70-74

Whitening Solutions

6-13

EdgeEndo

66-67 40-41, 77

SDI

42-43, 62-63

10-11, 85

GC 14-19

Septodont

GKE 50-51

Ultradent 12

Henry Schein

Vita 72-74

Henry Schein One

52-53, 86 46

Hu-friedy 58-61

White Dental Beauty

36-39, 78-79

7-9

YOUR GO - TO SITE FOR EDUCATIONAL CONTENT AND COURSES

DENTAL EDUCATION HUB.COM.AU Clinical content from leading global dental manufacturers updated weekly

Preparing For COVID Normal With over half of Australia spending the last few months in and out of lockdowns, and finally vaccinations reaching levels suitable for re-opening, we are left with the question; what is next and how do we prepare to make COVID-19 a normal part of our day to day lives when everything re-opens nationally? As we cannot eliminate COVID-19, it’s important to minimize the risks as much as possible. At Henry Schein both staff and customers will be protected by our measures which have been taken to protect our business: In September Rapid Antigen Testing was introduced for all employees working at our distribution center, air cleaners are installed throughout office spaces so no one goes without protection against this virus; beyond those two steps there is also a strong emphasis on Infection Control with PPE and clear Infection Control procedure at all our locations. Our staff are also using the same infection control products that you are in your practice, we back our brands and trust they keep you and us safe In addition, ensuring you have effective Infection Control protocols in place, we recommend a number of areas where you can further prepare your practice for COVID normal and reopening to full capacity: Rapid Antigen Testing At the point of writing this article, Rapid Antigen Tests are becoming more widely available, but can only be administered by registered healthcare professionals. The TGA however is indicating the tests may be made publicly available for use as soon as November. At present the rapid tests are only to be used for the purpose of testing staff and patients requiring urgent care. Since the TGA recently approved Dental Practices and the use of Rapid Antigen Tests for the screening of staff members and patients requiring urgent care, this has meant a big step towards getting back to being clinical. Being able to screen staff and patients requiring urgent care gives you peace of mind and reduces the impact on your business by minimising practice closures. Rolling out Rapid Testing can seem daunting, but Henry Schein has partnered with some key partners in diagnostics and are delivering extensive training on the Rapid Antigen Tests to make the roll out an easy transition for your practice to incorporate. Air Cleaning & Purification Many people are becoming more aware that clean virus free air in enclosed places can be a crucial factor for their own well-being. Introducing a HEPA filter-based air purification device into your dental practice could help keep the virus at bay, as well as creating peace of mind for your patients and staff.

Preparing your Equipment for Reopening As many dental practices have been forced to reduce their operating hours, and much of your equipment being left idle, it is important for you to ensure the equipment is in proper working order before reopening to full capacity, this includes ensure handpieces are oiled and Dental Water Lines are cleaned to remove biofilm build up. Contactless Patient Experience To minimize the amount of person to person contact within your practice, consider creating a contactless patient experience which turns many of the front of house interactions digital protecting both your staff and your patients. To find out more, Henry Schein One offers a free guide which you can download below. For more information on any of the above, we recommend you check out our Recover, Thrive & Grow brochure that we released in 2020 which has more information on many of these areas and more. Wishing you and your team a safe and successful transition to COVID normal and all the best for the festive period.

Download Contactless Patient Experience information

Download Recover Thrive and Grow information

ONLINE

EMMA JONES CICP-P Infection Control Category Manager

h en r y sc h e i n .c o m .a u

NEW PRODUCTS

NEW PRODUCTS SPOTLIGHT

In the last few months of 2021, Henry Schein in conjunction with our supplier partners are launching a number of new products to market with the aim of making clinical procedures simpler and more effective utilising the latest materials and technology. For more details and to read the full articles about these products, head to the new products section on page 75.

Kuraray Noritake – Clearfil Majesty ES2 Universal Clearfil Majesty™ ES-2 Universal is Kuraray Noritake’s latest innovation, a truly Universal composite with simplified shade selection, suitable for both anterior and posterior restorations. ES-2 Universal Combining exceptional aesthetics with unprecedented simplicity and superior mechanical properties and is indicated for class I,II, III, IV and V cavities - See page 76

EdgeEndo – EdgeFile X7 With New Sterile Packaging The number one selling file in the EdgeEndo range just got even better with the introduction of the sterile blister packs, eliminating the need to autoclave prior to use. EdgeEndo’s proprietary FireWire™ Heat-Treating process gives the EdgeFile X7, “Canal Contouring Technology,” making the files extremely flexible and reducing the shape memory and “bounce back” effect of other NiTi files - See page 76

Septodont – Ultra Safety Plus Twist Ultra Safety Plus has become the gold standard safety device, demonstrating its efficiency to protect the dentist and its staff from needle stick injuries and comply with the latest regulations. New Ultra Safety Plus Twist is safer and easier with its new intuitive patented locking system: only two easy steps are needed for a secure assembly. Also, the device is available as either sterile single use or with a sterilisable handle - See page 78

1 3 0 0

6 5

8 8

2 2

NEW PRODUCTS

Komet – SHAX Cutter Range The SHAX cutter range is the most innovative and efficient cutter ever created by Komet, offering an unprecedented combination of maximum substance removal and incredibly smooth surfaces. Due to its unique blade geometry, SHAX outperforms other existing cutters for non-precious metals up to 34% See page 80

Komet – Ceratip Komet has expanded its CeraLine range of innovative white instruments developed by adding the tissue trimmer CeraTip in cooperation with Prof. Dr. Sami Sandhaus. The CeraTip is made of a mixed ceramic composed of zircondioxide oxide partly stabilized by yttrium and aluminium ceramic. This high-performance material lends the CeraTip all the properties the user needs for perfect trimming of the gingiva - See page 82

B&L - B Kondenser Customised Condensers B&L’s latest range of customized condensers have a flexible end made from nickel titanium perfect for use in curved canals. The other end is made of stainless-steel and is ideal for compaction in the coronal and middle thirds of the canal - See page 84

SDI – Pola Light Introducing the new Pola Light 9.5% Hydrogen Peroxide Kit with an advanced whitening system combining Pola’s award winning whitening formula with targeted LED technology. The perfect whitening solution for your patients and all from the comfort of their own home - See page 85

Henry Schein - Eurosept Xtra Evac Cleaner Henry Schein proudly releases its Eurosept Xtra Evac Cleaner- a two-component system for effective cleaning and maintenance of dental suction systems. Regular usage of the Daily/Weekly system helps remove blockages, by dissolving existing organic and mineral deposits, and preventing the build-up of odour causing biofilm in the suction lines. These products are aldehyde-free, phenol-free, and chlorine-free, to reduce their environmental impacts - See page 86

h en r y sc h e i n .c o m .a u

WHITENING SOLUTIONS

WHITENING TOOTHPASTE HYDROGEN PEROXIDE VS. CARBAMIDE PEROXIDE

Have you been thinking about reviving your once vibrant and bright smile? You may be surprised by the number of whitening toothpastes available on the shelves. To help you make sense of all of the options when it comes to whitening toothpastes, here’s an overview of what ingredients to look for, how they work, and what effects they can have on your teeth

Common Whitening Toothpaste ingredients

Why use Whitening Toothpaste

Hydrogen Peroxide-Hydrogen peroxide has a long history as a bleaching agent in things like hair lightening products. When used in whitening toothpaste, hydrogen peroxide gently removes common food stains on the enamel and can make a big difference when it comes to whitening your smile. Hydrogen peroxide works by removing extrinsic stains and — in some cases — intrinsic stains, as opposed to toothpastes that use high cleaning silica, which only removes surface stains on the outer layer of the teeth.

Some stains on your teeth don’t react to whitening toothpastes because they become part of the internal structure of the tooth. However, if you use a whitening toothpaste, many of your deep set stains may diminish, depending on the source of the stain and how long it’s been there. Unlike whitening toothpaste, whiteners such as whitening strips or whitening gels are not designed to remove plaque and keep your teeth clean. These products only contain whitening ingredients and do not protect teeth against cavities. Whitening toothpastes are specially formulated to clean and protect your teeth while working to remove stains at

Because hydrogen peroxide is so good at whitening your teeth, it is true that higher concentrations can speed up the whitening process. But for safety reasons, higher percentages of hydrogen peroxide are only used during in-office teeth whitening procedures administered by your dentist. During professional whitening procedures, the level of hydrogen peroxide can be as high as 25% to 40%, which is far more than what is considered a safe amount for at-home use. Carbamide Peroxide- Used in both over-the-counter whitening products and home-use remedies from your dentist, water-based carbamide peroxide breaks down into two components: hydrogen peroxide and urea. After the breakdown occurs, the hydrogen peroxide is actually what whitens your teeth. A whitening product that contains 10% carbamide peroxide will typically break down to 3.5% hydrogen peroxide, depending on the concentration. If you’re unsure which whitening toothpaste ingredient is best, talk to your dentist before making a decision.

the same time.

Is Whitening Toothpaste Safe? When used properly and as directed by the manufacturer’s instructions, both hydrogen peroxide and carbamide peroxide based tooth whitening is safe and effective. Always read the manufacturer’s label to be aware of any risks and call your dentist if you experience any side effects. The most common side effect of using hydrogen peroxide to whiten your teeth can be teeth sensitivity. According to the American Academy of Pediatric Dentistry’s 2019 policy on dental whitening for adolescent patients, whitening should only be used on primary and young permanent teeth if supervised by an adult and under the guidance of a dentist. Don’t let surface stains keep you from sporting a confident smile. Ask your dentist about using a whitening toothpaste to make your pearly whites shine while keeping your teeth clean and protected.

They can help you find the best option for you to get the results you want.

*This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

1 3 0 0

6 5

8 8

2 2

WHITENING SOLUTIONS

THE “UNBLEACHABLE” DISCOLORATIONS TRUTH VS MYTH

Introduction Treating tetracycline stains is one of the biggest challenge for a dentist who deals with esthetics. The main side effect of this antibiotics during pregnancy is a deposition in the dentin of a developing tooth as calcification of a fluorescent pigment. At the time of the eruption, the dentin of these teeth show a brown to gray discoloration, and, consequently, aesthetic discomfort of the patients suffering from it. Looking to the past, the traditional approach was based on “subtractive” techniques aimed at covering the most severe discolorations after removing the overlying enamel. However we should think conservative for many reasons, but mainly as, although veneers are a simple and efficient solution, satisfactory results are only achieved with adequate thickness, meaning too prominent veneers, or preparations deep in dentin. So the question is…do we really need to touch sound enamel?

Fig.1

Fig.2

Fig.3

In 2020 a patient came to my office asking to improve the appearance of the severe tetracycline-induced dyschromia she suffered from. I first took a picture using a VITA shadeguide.

Polarized picture of discolored teeth. A polarized photo can be of great help from a diagnostic point of view to better frame the issue.

Model trimming for the fabrication of bleaching trays. First of all, alginate impressions were taken. Models were worked using a surgical blade to deepen the sulcus, to better follow the contour of the gingiva and avoid contact of the material with soft tissues. A 1 mm soft tray material was used to fabricate a custom-fit tray without placing any reservoir. Tray has to cover almost 3 mm of keratinized tissue. The particular consistency of this bleaching gel and a perfect custom-tray fit allow to avoid dilution of the material in the cervical area by saliva or bleaching gel leakage that could cause hypersensitivity.

According to Jordan and Boksman’s classification, prognosis of the bleaching was poor, but anyway I choose this procedure as the safest, cheapest and less invasive one. If the bleaching did not show significant success, it would still be preparatory to a rehabilitation with indirect restorations in order to have a lighter substrate.

The patient was instructed to putting a drop of bleaching gel the size of half a rice grain for each tooth in the tray. In this case, a 10% Carbamide Peroxide gel (White Dental Beauty) was chosen to be applied overnight, 6 days a week for 5 months. An appointment every 30 days was arranged and a 3mL syringe of bleaching product delivered to the patient.

h en r y sc h e i n .c o m .a u

WHITENING SOLUTIONS

Fig.4 Initial situation

Fig.5 1 month bleaching.

Fig.6 2 months bleaching.

Fig.7 4 months bleaching

Fig.8 5 months bleaching.

Fig.9 7 months and 2 weeks (after 2 months of lockdown) with 10% carbamide peroxide.

Fig.10 Dark teeth after bleaching for many months 8 months of which 2 weeks with 16% carbamide peroxide (White Dental Beauty).

Fig.11 Final result after 8 months and 2 weeks (and oral hygiene). 16% carbamide peroxide gel was applied for the last 30 days just to boost the bleaching effect.

Fig.12 An evident esthetic improvement was achieved without preparing teeth for veneers. Could we have done better? Absolutely. Yet, as the aim, when treating patients, is to satisfy them completely, in this case we really reached our goal.

1 3 0 0

6 5

8 8

2 2

WHITENING SOLUTIONS

[Fig.13] Details from the polarized picture after finishing the treatment.

[Fig.14] Before and after with polarized pictures.

Conclusion No sensitivity has been reported. A deep bleaching effect has been achieved with a very small amount of low concentration product placed in contact with enamel surfaces for a long time. This whitening compound contains hydrogen peroxide, urea and sodium tripolyphosphate and produces a pH jump into the alkaline pH range upon application, reducing the risk of sensitivity. Be careful when you choose your bleaching system: lower the PH of the product higher the sensitivity. Be sure to choose the right patient though. A 9 months treatment need a high level of compliance. Anyway a mild relapse (as you can see in the picture above) of the tooth shade at 9 months was observed compared with the immediate postbleaching result. Just tell your patient that nothing is forever in dentistry (except extraction, obviously).

Dr. Alessandro Martini Biography Graduated from Universidad Alfonso X el Sabio in Madrid. Passionate about aesthetic and functional restorative dentistry and runs a successful private practice in Verona. Since graduation Dr Martini has perfected his surgical skills by completing several annual courses including the Specialization in Oral Surgery, in Periodontology, and a II Level Master in Osteointegrated Implantology, for which he currently holds the clinical tutor.

DR ALESSANDRO MARTINI Universidad Alfonso X el Sabio in Madrid

h en r y sc h e i n .c o m .a u

WHITENING SOLUTIONS

TEETH WHITENING: TRIO OF TECHNIQUES

Whitening is a treatment of choice to equalize and lighten the colour of teeth, or when they feature different saturations. In this case, the patient presented root canals in teeth 1.1 and 1.2 performed two years ago, but with darkening only on tooth 1.1. Whitening is a treatment of choice to equalize

TEETH WHITENING: TRIO OF TECHNIQUES and lighten the colour of teeth, or when they

saturations. In this case, the Teeth whitening should alwaysfeature begindifferent with the most saturated patient presented root canals in teeth 1.1 and tooth, and tones should be gradually matched to ensure that 1.2 performed two years ago, but with darkening the tooth’s response is positive to the treatment, thereby only on tooth 1.1. averting the risk of exacerbating the discrepancy in tones.

Teeth whitening should always begin with the most saturated tooth, and tones should be gradually The technique of choice in this case to was to first perform an matched ensure that the tooth’s response is DRA. ISABEL internal whitening with 35% carbamide peroxide (PolaDay positive to the treatment, thereby averting the LUIS of exacerbating discrepancy CP GIRÁLDEZ 35%, SDI),DE combined withrisk night bleachingthewith 16% in tones.

Fig 1. Patient’s smile on the first visit. Fig 1.

Patient’s smile on the first visit.

Fig 5.

Pulp chamber opening on 1.1 to eliminate residue of gutta-percha and apply 35% carbamide peroxide for internal whitening.

Expert in Aesthetic and Restorative carbamide peroxide (PolaNight SDI) exclusively on was tooth The16%, technique of choice in this case to first Dentistry at the CIRO Dental Clinic 1.1.(Madrid). Internal whitening replacements three perform anwere internalconducted whitening with 35% carbamide Associate Professor at the peroxide (PolaDay CP 35%, SDI), combined with Universidad Juan Carlos. times, fiveRey days apart. Madrid.

night bleaching with 16% carbamide peroxide

(PolaNight 16%, SDI) exclusively on tooth 1.1. Upon confirming that the saturation of 1.1 was subsiding, it Internal whitening replacements were conducted was decided to close the access to the pulp chamber and three times, five days apart. to continue with the night whitening, adding 16% carbamide Upon confirming that the saturation of 1.1 was peroxide on the canines and, subsequently, the rest of the subsiding, it was decided to close the access teeth. This procedure was continued a month and a half. to the pulpfor chamber and to continue with the night whitening, adding 16% carbamide peroxide the canines subsequently, the rest of To complete the treatment, a on session wasand, held at the dental the teeth.(PolaOffice This procedure+,was continued for a offices with 37% hydrogen peroxide SDI). month and a half.

Fig 5. Pulp chamber opening on 1.1 to eliminate residue of gutta-percha and apply 35% carbamide peroxide for internal whitening.

To complete the treatment, a session was held at the dental offices with 37% hydrogen peroxide (PolaOffice +, SDI). Fig 9.

Evolution in the cervical third of 1.1 after the second replacement of 35% carbamide peroxide.

Fig 9. Evolution in the cervical third of 1.1 after the second replacement of 35% carbamide peroxide.

1 0

1 3 0 0

6 5

8 8

YOUR SMILE. OUR 2 2 VISION.

SDI Germany GmbH Telefon: Deutschland: 0800 100 57 59 Österreich: 00800 022 55734 WWW.FACEBOOK.COM/SDI.GERMANY WWW.SDI.COM.AU WWW.POLAWHITE.COM.AU

WHITENING SOLUTIONS

Aesthetics

Fig 2. Initial colour measurement of the middle and incisal third of 1.1.

Fig 3. Initial colour measurement of the cervical third of 1.1.

Fig 4. X-ray of 1.1 and 1.2 to confirm that the state of the endodontics is adequate and that an internal whitening treatment can be performed on tooth 1.1.

Fig 6. Evolution of the incisal third of 1.1 after the first replacement of 35% carbamide peroxide.

Fig 7. Evolution of the cervical third of 1.1 after the first replacement of 35% carbamide peroxide.

Fig 8. Evolution of the incisal third of 1.1 after the second replacement of the 35% carbamide peroxide

Fig 10. Final result of the whitening. A positive response by 1.1 with internal plus external whitening is observed. Tooth 1.2, despite endodontic treatment, responded well to treatment with external whitening alone.

Fig 11. Final photo of the smile, for comparison with the initial photo.

Fig 12. Colour measurement at the end of the treatment, after the application of 16% carbamide peroxide on the rest of the teeth and after the office consult session with 37% hydrogen peroxide.

DRA. ISABEL GIRÁLDEZ DE LUIS Expert in Aesthetic and Restorative Dentistry at the CIRO Dental Clinic (Madrid). Associate Professor at the Universidad Rey Juan Carlos. Madrid.

h en r y sc h e i n .c o m .a u

1 1

WHITENING SOLUTIONS

LIGHT VS NO LIGHT IN TEETH WHITENING

Your patients are seeing it all over social media, television, and beauty blogs, so no wonder they’re demanding whitening treatments that use some kind of light!

in the minds of patients when, in reality, the light creates a very temporary whiter result, and can cause other negative side effects, including oral burns and pulpal stimulation2.

So, how do you educate them on the reality behind tooth whitening and the effectiveness products that use lights vs. those that do not?

Secondly, lights used in many whitening systems simply dehydrate the teeth, which gives them a temporary whiter appearance. It is not uncommon to find that many of these same patients experience a significant colour rebound.

The first and most important thing to help your patients understand is that the evidence from more than a dozen independent clinical trials show that tooth whitening using lights will not improve whitening effect.1

Dehydration can be a factor in tooth sensitivity, so the more dehydrated the patients’ teeth are due to light exposure, the more relapse and sensitivity they are likely to experience.

Patients were introduced to the idea of light used whitening treatments years ago on shows like Extreme Makeover, and this has prevailed and stuck

Opalescence™ Boost™ in-office whitening offers patient’s an in-office, dramatic whitening experience without the use of a light, helping patients to avoid unnecessary sensitivity.

The good news is that there are safe and effective alternatives, without the use of a light or any other gimmicks. The most effective way to whiten teeth with the least risk of sensitivity and shade relapse is through prolonged exposure to pH stable and optimized active whitening agents on the tooth’s surface. This can be achieved in-office with Opalescence™ Boost™ or at-home with the use with dentist-supervised products like Opalescence™ PF and Opalescence Go™ , all of which formulated with desensitising agents and a high water concentration to provide extra safeguards against sensitivity, dehydration, and shade rebound.

References: 1. Maran, M.M., et al (2018). In-office dental bleaching with light vs. without light: A systematic review and meta-analysis. Journal of Dentistry, 70(2018) 1-13. 2. Bruzell, E.M., et al (2009). In vitro efficacy and risk for adverse effects of light-assisted tooth bleaching. Journal of Photochemical & Photobiological Sciences, 2009, 8, 377-385.

1 2

1 3 0 0

6 5

8 8

2 2

Scan the QR code for additional independent study references

WHITENING SOLUTIONS

A QUICK GUIDE TO BLEACHING SPLINT WORKFLOW

BIOPLAST bleach is a soft elastic rubber-like thermoforming material made of ethylene vinyl acetate (EVA) that does not bond to acrylic. The material does not require pre-drying before pressure moulding, as it is not hygroscopic. The material has been tested and approved in terms of cell biology and in accordance with the international standards ISO 10993 and ISO 7405. Indication

Pressure moulding

BleachingGenerally splint speaking, we recommend to place dental Due to its material characteristics, BIOPLAST bleach is ideally suited for bleaching splints and medical arches on the model and to embed full models into Bleaching splint Material List: trays. The material has a higherBIOPLAST degree of stability the pellets. Adhesion of pellets to the model and bleach 1.0 mm or Material List: COPYPLAST 1.0ensuring / 1.5 / 2.0 mm or a than the standard BIOPLAST material, the resulting loss of pellets can be considerably BIOPLAST bleach 1.0 mm or BLUE-BLOKKER (space maintainer) COPYPLAST(REF 1.0 / 1.5 /3006 2.0 mm or large/ more precise marginal adaptation. reduced by using the pellet cover BLUE-BLOKKER (space maintainer) REF 3007 small). Preparing the model Finishing Apply BLUE-BLOKKER that serves as a space ®

Bleaching You splint holder in the required layer thickness to the surfaces can reduce the splint to its final extension using that you want to bleach or treat. recommend the foil A (REF 3460) and DIMO® PRO SLIM 1 Insulating andscissors embedding MarkWe the areas you want to bleach with a pencil. Apply BLUE-BLOKKER serving Material as space List: maintainer in the desired layer thickness. Mark the areas you want to bleach with a pencil. Apply BLUE-BLOKKER using BIOPLASTIC insulating agent / (REF 3376). BIOPLAST (REF bleach 1.03189 mm or as space maintainer in the desired layer thickness. 1.0/1.5/2.0 mm or COPYPLAST 3166) for model isolation. Apply one thin layer of Cleansing/care BLUE-BLOKKER (space maintainer) the insulating agent to the model, making sure to CETRON cleansing and care products are the best prevent the liquid from accumulating in the cavities choice for splints made of BIOPLAST bleach. as well as from drying out.

Insulating and embedding

serving

Insulatingmoulding and embedding Pressure

2 Pressure moulding ® Mark areas arcade you wantmodel to bleach a pencil. Apply serving Placethedental on with the platform resp.BLUE-BLOKKER embed complete model

space in the layer thickness. 1. asinInsulating and embedding pelletsmaintainer and fill cup up desired to the upper rim. Pressurize BIOPLAST® bleach or ® COPYPLAST depending the desired Mark the areas youonwant to stability and model size. bleach with a pencil. Apply BLUE-BLOKKER serving as space maintainer in the desired layer thickness.

2 3

Pressure moulding Finishing

3 Finishing Place dental arcade model on the platform resp. embed complete model Cut the foil radially, remove it carefully from model and cut it to®exact length. in pellets and fill cup up to the upper rim. Pressurize BIOPLAST bleach or COPYPLAST® depending on the desired stability and model size.

3. Finishing

Cut the foil radially, remove it carefully from model and cut it to exact length.

dental arcade model on the platform resp. embed complete model 2.Place Pressure moulding in pellets and fill cup up to the upper rim. Pressurize BIOPLAST® bleach or ® Place dental arcade depending on themodel desired stability and model size. COPYPLAST on the platform resp. embed complete model in pellets and fill cup up to the upper rim. Pressurize BIOPLAST bleach or COPYPLAST depending on the desired stability and model size.

Cut the foil radially, remove it carefully from model and cut it to exact length.

Tips and tricks The light curing blocking-out material BLUE BLOKKER® can be applied easily and precisely in the desired layer thickness.

Finishing

Tipsit and tricks: Cut the foil radially, remove it carefully from model and cut to exact length. The light curing blocking-out material BLUE BLOKKER® can be applied easily and precisely in the desired layer thickness. Tips and tricks: Following the same procedure, you may as well fabricate medical trays. ® The light curing blocking-out material BLUE BLOKKER can be applied easily and precisely in the desired layer thickness. Following the same procedure, you may as well fabricate medical trays.

h en r y sc h e i n .c o m .a u

1 3

PREVENTATIVE SOLUTIONS

TOOTH MOUSSE / PLUS

GC Tooth Mousse™ Plus is a delicious tasting crème containing a milk-derived protein called RECALDENT® with incorporated fluoride (CPP-ACPF: casein phosphopeptide-amorphous calcium phosphate fluoride). The level of fluoride is 0.2% w/w (900 ppm) which approximates that in adult strength toothpastes. Because calcium, phosphate and fluoride are carried in a special milk-derived protein called RECALDENT (CPP-ACP), they are available in a soluble form. This means GC Tooth Mousse Plus can provide extra protection for teeth, buffer dental plaque acid from bacteria in the mouth and also protect teeth from acidic foods and drinks.

Daily extra protection GC Tooth Mousse Plus contains 900 ppm fluoride and is recommended for: •

Children older than 6 years old*

•

Patients where additional fluoride exposure is desired*

*If GC Tooth Mousse Plus is not recommended, then GC Tooth Mousse is an alternative fluoride-free product

People and their lifestyle choices Depending on lifestyle choices, such as frequent consumption of acidic foods and drinks, teeth will be attacked by acid coming from bacteria in your mouth and/or from a diet a few times a day. Regular use of GC Tooth Mousse Plus provides daily extra protection for your teeth in those situations

People who depend on carers Some people depend on carers for assistance related to basic activities of daily living. Some individuals can experience difficulty with teeth/mouth hygiene, such as brushing teeth, and their teeth may require extra protection in these circumstances.

1 4

1 3 0 0

6 5

8 8

2 2

PREVENTATIVE SOLUTIONS

What do regular users of GC Tooth Mousse Plus say about their experience? A recently published study reported on noticeable differences between participants’ experiences before becoming a regular user of GC Tooth Mousse Plus (TMP) and after having done so. According to Sbaraini et al. (2021), it was evident that “participants went through a process of change: without exceptions, they described experiencing a profound change in their oral health and their quality of life because of that^” as cited below: “The first time I went to my dentist for my 6-month check and went out without having to get any [restorative] work I was sold. Do you know what I mean? That was all I needed, I just thought it must be TMP. Then, when it happened again, and then a third time, I just was gob-smacked.” research participant ID4, female, 55-64 years old, NSW* “I’m excited and feel like TMP keeps me smiling. I just sense I am doing the right thing in maintaining my oral health.” research participant ID14, male, 45-54 years old, NSW* “I think it’s an essential part of my life now – I would never be without TMP” research participant ID1, female, 65 years or older, NSW* “I think that to keep my own teeth is really important. So, the fact that it takes me a few more minutes to apply TMP is not important to me at all…. It is a bit like exercising every morning before breakfast so that just becomes part of life. I do not even think about it now, its just part of life. This is tooth protection that I can do at home. It became part of the things that I do every day, like eating meals and so on.” research participant ID11, male, 65 years or older, sensitivity, NSW*

GC Tooth Mousse Plus

GC Tooth Mousse

™

Nature knows best Made from cow’s MILK

Nature knows best

Scan for brochure

Made from cow’s MILK

Scan for brochure

Research conducted by Alexandra Sbaraini, Geoffrey G. Adams and Eric C. Reynolds, Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne. The authors received no financial support. GC Australasia Dental Pty LTD provided tubes of GC Tooth Mousse Plus. Which were given to participants after interviews. GC Australasia Dental Pty Ltd had no input in the design of the study, the collection, analysis, interpretation of data, and writing the manuscript. Study available from Sbaraini, A, Adams, G.G & Reynolds, E.C. Experiences of oral health: before, during, and after becoming a regular user of GC Tooth Mousse Plus. BMC Oral Health 21, 14 (2021). https://doi.org/10.1186/s12903-020-01360-8. * Testimonials were extracted from research data displayed on Sbaraini et al. BMC Oral Health (2021) 21:14 https://doi.org/10.1186/ s12903-020-01360-8. Ethics approval for the study was obtained from the Human Research Ethics committee at the University of Melbourne (HREC ID: 1748963). As in any ethical study, participation was voluntary, and participants’ confidentiality was protected. During the research, participants received a tube of TMP as recognition of the participants’ time. The research participants are not immediate family members of an individual who is involved in the production, sale, supply or marketing of Tooth Mousse Plus.

h en r y sc h e i n .c o m .a u

1 5

COSMETIC & RESTORATIVE

G-CEM VENEER LIGHT-CURING RESIN CEMENT

Aesthetic dentistry is evolving towards less invasive preparations, while still maintaining highly aesthetic restorations. The drive towards minimal preparation, and reduction in the resulting restorative material thickness means the luting and the handling of adhesive resin cement becomes ever so important. Featuring a perfect viscosity and high physical performance, G-CEM Veneer has been designed to offer a standardized luting protocol for indirect restorations requiring a light-curing resin cement. This case presented illustrates the use of the light-curing G-CEM Veneer resin cement for a high aesthetic demanding case that was restored with bonded ceramic veneers. The final result is one that meets the most demanding aesthetic criteria by providing a natural result with incorporated fluorescence.

Initial presentation

After preparation, application of phosphoric acid etch

Application of G-Premio BOND

Application of hydrofluoric acid etch

Application of silane (G-Multi PRIMER)

Application of G-CEM Veneer Bleach shade

Excess removal

Final result immediately post operative

Images courtesy of Dr A Mak, Sydney

1 6

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

WHERE CORE STRENGTH MATTERS FIBRE-REINFORCED FLOWABLE COMPOSITE

everX Flow is a highly fracture tough, reinforcing composite substructure incorporating unique micro-fibre and full silane coverage technologies. To help you achieve stronger and more

durable posterior restorations*, place everX Flow as a dentine replacement under composite or use as a core under indirect prostheses. everX Flow uses the Optimal Aspect Ratio (OAR) Technology. everX Flow’s E-glass fibres demonstrate a critical length to diameter ratio to provide an optimal reinforcement effect. FSC (full silane coverage) technology is also used for both the filler particles and fibres in everX Flow, to deliver maximum strength and durability. SFRC (short fibre-reinforced composite) can be used as a direct core build-up material that can effectively resist heavy occlusal forces against fracture and can reinforce the remaining tooth structure in endodontically-treated teeth. Several studies have shown that the fibre-reinforced composite substructure supports the composite restoration and serves as a crack-prevention layer.*

everX Flow provides maximum reinforcement for optimum fracture resistance*

Initial Situation

Removal of old restoration and mesio-palatal wall build-up using G-ænial® Universal Injectable

Placement of sectional matrix and proximal wall build-up using G-aenial® Universal Injectable

Application of everX Flow as a dentine replacement material

Application of enamel replacement material and occlusal build-up using Essentia® Universal

Final restoration

Clinical Images courtesy of Dr Georg Benjamin, Germany *Garoushi S, Lassila LVJ, Tezvergil A, Vallittu PK. Static and fatigue compression test for particulate filler composite resin with fiber-reinforced composite substructure. Dent Mater 2007e;23:17-23. https://pubmed.ncbi.nlm.nih.gov/16414110/ Alvanforoush N,Palamara J, Wong RH, Burrow MF. Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995-2005 and 2006- 2016 periods. Aust Dent J 2017 Jun;62(2):132-145. doi: 10.1111/adj.12487. Epub 2017 Apr 19. https:// pubmed.ncbi.nlm. nih.gov/27861960/

h en r y sc h e i n .c o m .a u

1 7

COSMETIC & RESTORATIVE

INITIAL LISI PRESS LITHIUM DISILICATE GLASS CERAMICS

Natural Beauty Restored Lithium disilicate is a glass ceramic with proven clinical success and is known for its excellent combination of strength and aesthetics. At GC, we now further optimise these qualities thanks to the proprietary innovative fabrication technology used in Initial LiSi Press, a high-strength lithium disilicate glass ceramic material.

LiSi Press veneers facebows were taken and sent to the master ceramist Bill Marais in Portland, USA.

The patient was looking for solutions to address the large bulky anterior veneers she currently had. She was also unhappy with the shape and the colour of her front teeth. Being relatively young, the patient also wanted to avoid aggressive tooth preparation of her natural tooth structures.

A digital mock up of the six anterior teeth was carried out following a minimally invasive protocol to produce the LiSi Press veneers. 6 LiSi Press monolithic veneers were made with minimal thickness. The detailed ceramic work in this case highlights the very aesthetic qualities and the ability to achieve high value restorations with monolithic LiSi Press and GC Initial stain and glaze

A comprehensive exam and the acquisition of the necessary diagnostic records were completed. A treatment plan consisting of a combination of orthodontic movement and minimal tooth preparation for ceramic based porcelain veneers were accepted.

The final result was not only conservative but also aesthetic, meeting the expectations of both the clinician and the patient.

Once orthodontic treatment was completed, full digital records with intra-oral scans and digital

Before

Digital planning

Preparations

Completed veneers

Cementation

Final

Images courtesy of Dr Anthony Mak, Sydney

1 8

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

ADVANCED UNIVERSAL COMPOSITE SIMPLICITY, AESTHETICS AND PERFORMANCE IN YOUR HANDS

With more than 100 years of experience in serving dentistry and over one billion composite restorations worldwide, GC introduces its proprietary High-performance Pulverised CERASMART (HPC) filler and Full-Coverage Silane Coating (FSC) technologies with its latest universal composite G-ænial A’CHORD which brings together simplification, invisible fillings, natural fluorescence and advanced technologies in one syringe.

Simplified handling G-ænial A’CHORD provides consistently simplified handling, whether sculpting with a hand instrument or using a brush. This is enabled by the non-sticky Bis-MEPP monomer and optimized filler-monomer combination of proprietary FSC and HPC technology.*

Simplified unishade G-ænial A’CHORD always delivers more: a simplified unishade system of 5 core shades that achieves the aesthetics of the 16 classic Vita shades with ease. With this reduced inventory, you will save time and costs. Its unique filler technology mimics natural light reflection resulting in impressive invisible restorations.

Images courtesy of Dr Yo-Han Choi, Australia

* (GC data on file)

h en r y sc h e i n .c o m .a u

1 9

COSMETIC & RESTORATIVE

SIMPLIFYING POSTERIOR COMPOSITE RESTORATIONS DR ADHAM ELSAYED DISCUSSES CLEARFIL MAJESTY™ ES-2 UNIVERSAL

In this interview, Dr Adham Elsayed, certified specialist in dental prosthodontics and implants and clinical and scientific manager at Kuraray Noritake Dental, details the benefits of the company’s new CLEARFIL MAJESTY™ ES-2 Universal composite and explains its application in the daily dental workflow. Though dentists are becoming increasingly specialised, there’s a growing demand for products that can be used for all indications. How does CLEARFIL MAJESTY™ ES-2 Universal fit this model? First, we need to explain the meaning of the term ‘universal’ in this context. Previously, there have been two types of composites that differ according to the area of application: anterior composites, used in Class III, IV and V restorations where the aesthetic outcome is the priority, and posterior composites, in which the mechanical properties like strength and wear rate are more important. Universal composites, then, are those that can be used for all types of restorations in the anterior as well as the posterior region. Another way in which ‘universal’ can be considered is in relation to shade. In this case, the term is used to describe a restorative composite system that exists in fewer shades, one that can adapt to the tooth structure independent of the colour of the tooth. A major benefit of this type of composites is that it offers a simplified workflow. CLEARFIL MAJESTY™ ES-2 Universal is essentially universal in both meanings: it is one system that can be used for posterior and anterior restorations, and it is also provided in only three shades—one for posterior, and two for anterior.

Universal products, whether they are luting cements, bonding agents or composites, are attractive to dentists as long as they offer simplification of the treatment procedure without compromising quality and durability.

2 0

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

How does CLEARFIL MAJESTY™ ES-2 Universal build upon the success of the CLEARFIL MAJESTY™ range? The CLEARFIL MAJESTY™ family is very well established at this stage. It includes such products as CLEARFIL MAJESTY™ Posterior, one of the most popular posterior composites owing to its superior mechanical properties and minimal polymerisation shrinkage. CLEARFIL MAJESTY™ ES-2 is an extensive system that is highly beneficial thanks to its outstanding optical properties and ability to produce high-end aesthetics in the anterior region using Kuraray Noritake Dental’s multilayering technique. CLEARFIL MAJESTY™ ES Flow, (Low Flow) is another successful member of the family. Kuraray Noritake Dental now continues the success story of CLEARFIL MAJESTY™ with the latest innovative product that can change the definition of the universal composite. CLEARFIL MAJESTY™ ES-2 Universal incorporates several attributes from the well-established ES-2 and ES Flow, including Kuraray Noritake Dental’s light diffusion technology (LDT). Speaking of LDT—how does this technology benefit the composite? LDT allows the material to scatter and reflect light rays at many different angles, which, in turn, allows the composite restoration to diffuse light in a similar way to the surrounding tooth structure. Hence, it eliminates aesthetic problems like the visibility of restoration and preparation borders. Thanks to innovative LDT, optimal particle fillers and opacity, CLEARFIL MAJESTY™ ES-2 Universal blends seamlessly with the surrounding tooth structure and emulates natural teeth, eliminating the need for shade selection.

As you mentioned, CLEARFIL MAJESTY™ ES-2 Universal comes with one shade for posterior restorations and two for anterior restorations. Can such a reduced shade range still truly deliver aesthetic restorations? CLEARFIL MAJESTY™ ES-2 Universal is not the first composite on the market with a reduced shade system. However, we can safely say that it is the first to focus on aesthetics and not just on reducing the number of shades. We know from experience that using one-shade composite systems in the anterior region mostly leads to unsatisfying aesthetic results, even with the use of an opaquer composite to reduce shade-matching interference. This is due to the fact that trying to provide one shade for all posterior and anterior restorations, and for all tooth shades, compromises the aesthetic to a high extent. In other words, using a highly translucent material to try to match all restorations and shades will result in the interference of other objects in the mouth, such as the tongue, gingivae and so on. Kuraray Noritake understood this fact well and solved the problem by introducing three shades with translucencies designed to match specific indications. It is important to note the simplicity of the workflow, since only one syringe per restoration is required. This makes CLEARFIL Majesty™ ES-2 Universal a true game-changer, as it provides the perfect match between simplicity and aesthetics.

h en r y sc h e i n .c o m .a u

2 1

COSMETIC & RESTORATIVE

What other advantages does this new composite deliver?

Which dental professionals would benefit most from this product?

Other advantages include the superior mechanical properties for which the CLEARFIL MAJESTY™ family is already known, such as favourable wear properties, low shrinkage stress and high strength.

The perfect match between simplicity and aesthetics offers the clinician several benefits. It delivers a very straightforward time-saving procedure without compromising aesthetic results.

It can be polished easily and retains its gloss. Moreover, the handling of the material is a huge advantage: this includes a long working time of about 270 seconds under ambient light. It is nonsticky and can be sculpted easily.

There is no need for exact shade selection, thereby excluding visible errors of non-matching shades, and there is also a reduced amount of material stock needed. Therefore, in my opinion, this should be the product of choice for most cases in everyday practice. Advances and developments in dental materials are rapidly accelerating, and clinicians should integrate these innovations and make their daily practice more efficient with simplified workflows, timesaving procedures, fewer material selections and, accordingly, less technique sensitivity and less need for dental practice personnel to become acquainted with an abundance of materials.

™

JEST Y FIL MA CLEARl shade concept Univer

tion? cal situa every clini in virtually l rations le universa aling resto . A sing create appe the trick there are es will do region, a few shad anding anterior ept, just more dem de conc ally sha l hetic ersa ™ ES-2 Univ How In the aest lly available. rations. IL MAJESTY posterior resto additiona is ARF e for CLE for all white shad If you opt o solution from. An extra the go-t se shade is to choo e options s. This is two shad lar case your regu usion region for Light Diff anterior Dental’s equence, DED! Noritake nor in the . As a cons me posterior ration of Kuraray structure does QUER NEE beco er in the neith NO OPA on margins the integ – way tooth needed preparati ency and a similar light in ture and uer is not level of transluc or opaq n distort tooth struc ific ker ratio ing spec bloc A the resto surround material’s makes into the due to the (LDT), which smoothly and gy ly Technolo integrates easi rial the mate invisible. virtually

THETIC

SS AES

EFFORTLE

-2es

rent many diffe

Univer

INTELL

IGENT

SIMP

shades

of composi

te do you

need to

sal shad

TION LIFICA

s toration osite res ect comp sterior e for po s One shad toration res ior for anter uired options uer req o shade No opaq For all dir

ES-2

with mission Light trans LDT without mission Light trans

ANS

, THIS ME

FOR YOU

a Simplified

shade sele

www.k

ction with

out a shad

e guide

e procedur uer) fortable ker or opaq e, no bloc s work step r-prone ntially erro results Fewer pote t, predictable isten for cons s that last outcome Appealing nt and com

fficie omle-shade techniqu ae.c E(sing itak uraraynor

LDT

Before

e the sam l offers : Universa ecessors Y™ ES-2 its pred IL MAJEST properties as CLEARF ical mechan 118 MPa superior : 78 wt% Strength Flexural 347 MPa : Filler Load ngth: 1.9 % sive Stre Compres nkage: 2.0 mm ric Shri Volumet sec. t: 270 Depth: ient ligh Curing er amb time und Inc. Working Source:

Kuraray

Noritake

Download product brochure information here

Dental

2 2

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

PANAVIA V5 TM

PREDICTABLE PROCEDURE - PROVEN ADHESIVE STRENGTH

PANAVIATM V5. The cement for literally all permanent cementation indications, irrespective of the preparation or the material for bonding! The predictable procedure of PANAVIATM V5 surprises by its unrivalled simplicity. Unique PANAVIATM V5 Tooth Primer for pre-treatment of tooth tissue. CLEARFILTM CERAMIC PRIMER PLUS for pre-treatment of the restoration. 50 Shear bond strength (MPa)

PANAVIATM V5 is available in no fewer than five aesthetic shades and with its unparalleled adhesive strength it stands head and shoulders above other cements thanks to the unique MDP monomer. Experience this simplified cementation method yourself. Standard handling of PANAVIATM V5 ensures predictable results – time and again.

40 30

31.2 25.2

20 10 9.7

Research PANAVIA V5: the highest proven adhesive strength

43.8

Panavia V5

The objective of this research, conducted by Dental Advisor, was to establish the adhesive strength of PANAVIATM V5 to human dentine in comparison with three other commercially available composite cements by using the Ultradent shear bond strength test involving a 24 hours’ immersion in water (37º C). In a second research run, the new composite system HPC-100 (the working name for PANAVIATM V5) also showed the highest adhesive strength to human dentine, after 24 hours and following thermo cycling (TC3000), in comparison with the two other composite cementation systems. This research has shown that HPC-100 provides reliable clinical performances and that it is superior to the other composite cementation systems that were tested during this research.

PANAVIATM V5 provides the highest adhesive strength to human dentine as compared to the other composite cements tested.

RelyX Ultimate1

Multilink Automix1

Bron: R. Yapp, M.S., M. Cowen, BS, J.M. Powers, Ph. D. The DENTAL ADVISOR Biomaterials Research Center Dental Consultants, Inc., Ann Arbor, Michigan

(MPa) 30 37OC, 24 UUR TC3000

25 20 15 10 5 0

Conclusion

RelyX Unicem 2 Automix1

HPC-100

RelyX Ultimate1

Multilink Automix1

Adhesive Property of a Newly Developed Resin Cement System “HPC-100”, N. Kashiki, M. Takei, H. Nakayama, Kuraray Noritake Dental Inc., Tainai, Japan 1.

Not a trade mark of Kuraray Co., Ltd.

h en r y sc h e i n .c o m .a u

2 3

COSMETIC & RESTORATIVE

CEMENTATION OF ZIRCONIA CONSIDERATIONS FOR OPTIMAL RESULTS

Reliable adhesive cementation of zirconia 10-Methacryloyloxydecyl Dihydrogen Phosphate is a bit of a tongue-twister for anyone who is not a chemist by profession, so in everyday communication, this adhesive monomer is referred to by the three initial letters: MDP. MDP is indispensable in the dentistry business. For example, reliable adhesive cementation of zirconia restorations would not be possible without MDP. This adhesive monomer was developed by Kuraray Noritake Dental in 1981.

KATANATM Zirconia UTML

Requirements Indirect restorations in modern dentistry must fulfil at least three requirements. First of all, they must be tissue-saving. This implies that a full crown is not the first choice, because approximately 70% of the tooth tissue has to be sacrificed for such a restoration. Nevertheless, full crowns are often still indicated by virtue of their mechanical retention. But given that the retention which can be achieved by adhesive cementation is now sufficiently reliable, a less invasive restoration than a crown should be chosen more often.

KATANATM Zirconia STML

And this choice may very well be for a zirconia restoration. Combined with the preliminary sandblasting of such an adhesive restoration, this choice is now an appropriate one thanks to MDP. Durability is the second requirement for an indirect restoration. This quality of a restoration is largely associated with the flexural strength of the restoration material. While it has become clear that zirconia achieves the best durability scores, it should be pointed out that the cementation method also contributes significantly to the durability of a facing, inlay, onlay, etching bridge etc., which can nowadays all be realised in zirconia.

KATANATM Zirconia ML

Aesthetics Aesthetic acceptability is the third requirement for a modern indirect restoration. This means that porcelain baked on metal has become a thing of the past; full-ceramic materials are now the standard.

2 4

1 3 0 0

These veneers were made from KATANATM Zirconia UTML and coloured using CERABIENTM ZR External Stain

6 5

8 8

2 2

COSMETIC & RESTORATIVE Zirconia still has a relatively poor reputation in terms of aesthetics due to the extreme whiteness of the earliest examples from the turn of the century. Types of zirconia are now available with varying translucencies, and there are even so-called multilayer varieties (KATANATM Zirconia ML, STML and UTML by Kuraray Noritake), and these new zirconia no longer have to be porcelain-baked. Obviously, baking is still possible, and partial baking is a choice that is frequently made.

As for surface structure, the fact that the material allows for the smooth polishing of the occlusal plane is crucial to counteract abrasion by the antagonist and to maintain the occlusal balance. In this respect, the hardness of the material selected is not the main factor; the smoothness and resistance of the surface are far more important.

Flexural strength When selecting material for restorations, the dental technician also has the option to choose KATANATM Zirconia Ultra Translucent Multi-Layered for veneers or anterior crowns; a zirconia with a translucence comparable to that of glass. This translucence is especially important with anterior restoration which is to be fitted between flawless natural elements, a situation that often occurs after anterior traumas. Such a restoration effected using KATANATM Zirconia UTML harmonises with the neighbouring natural teeth, not least because this type of zirconia does not cause the frequently-occurring white appearance common in anterior crown. The modern aesthetic zirconia materials of the second generation are sintered at a temperature of 1,550°.

One of the results of a multi-layer build-up is that the transparency is higher incisally than cervically, as it is in natural elements; the light falls through the incisal margin, but is blocked at the cingulum of the restoration. With a modern zirconia material such as KATANATM Zirconia ML, this variable transparency goes hand in hand with a natural colour gradient from cervical to incisal. In a given colour, A1 for example, the cingulum has the corresponding dentine shade body and it passes to incisal in the appropriate enamel colour via two transition shades.

Surface

This temperature is maintained for two hours. The dental technician needs to be aware that this temperature differs from the sintering temperature for KATANATM Zirconia High Translucent MultiLayered (1,500 °C). Wide-span bridges can be realised with the latter product, whereas the size of bridges made from KATANATM Zirconia Super Translucent Multi-Layer remains limited to a maximum of four elements. KATANATM Zirconia UTML can be used for small anterior bridges, but is more suitable for anterior crowns and veneers.

The new zirconia materials are changing the way dental technicians operate, as illustrated by the experience of Daniele Rondoni, a renowned dental technician. This professional, from Savona in Italy, has specialised in the use of Multi-Layering technology for ceramic materials (Tecnica della Multistratificazione in Ceramica). According to his philosophy, the choice of restoration materials should be so wide that customised solutions can be realised. Among other things, he believes that there will still be room for baked porcelain on a core of lithium disilicate or zirconia. Using baked porcelain, the dental technician can modify the surface texture of an aesthetic restoration to lend, as it were, a certain age to the restoration.

The reason for this is that the flexural strength of these highly aesthetic zirconia materials is lower than the flexural strength of the standard zirconia, in which the flexural strength

Minimum wall thickness of KATANATM

UTML

* Maintain 0.8 mm thickness of pressed ceramic in all areas. When trimming of the zirconia framework the framework should be at least 0.4 mm.

STML

1,0 mm 0,8 mm 0,8 mm

1,0 mm

0,4 mm

0,8 mm 0,8 mm

1,0 mm

0,4 mm 0,8 mm

Anterior crown

0,4 mm

Veneer

Inlay

Posterior crown

Onlay

ML & HT 0,5 mm 0,4 mm 0,4 mm

0,5 mm

0,4 mm

0,4 mm 0,4 mm

0,5 mm

0,4 mm 0,4 mm

Anterior crown

0,4 mm

Veneer

Posterior crown

h en r y sc h e i n .c o m .a u

Inlay

Onlay

2 5

COSMETIC & RESTORATIVE rubber dam must be applied for the operation, which is obviously easier for partial restorations than for total restorations. It is not only from the perspective of tissue-saving that it is useful to keep the preparation limited for this reason. The second condition is that micro-mechanical adhesion needs to be achieved. For zirconia restorations, the necessary adhesion is obtained by sandblasting the surface. Obtaining chemical adhesion is the third condition.

– 1,125 MPa – is sufficient for the production of durable wide-span bridges. The flexural strength of the highly aesthetic zirconia varieties (approximately 750 MPa (STML) and 550 MPa (UTML)) is amply sufficient to ensure the durability of solitary aesthetic restorations and limited-span bridges.

Preparation Flexural strength is not the only decisive factor for durability; the method of preparation is also crucial to properties of this material. Chamfer preparation is the required form of preparation, with no knife-edge outline, no deep shoulder and, obviously, no undercuts. Since the restorations are fixed adhesively, parallel walls or grooves in the preparation are undesirable, and sharp edges and transitions must be rounded off. 1If a preparation for a full crown has nevertheless been made, a substantial height difference between the vestibular and palatal/lingual outline is contra-indicated.

Based on extensive research, Kern is fully convinced that chemical adhesion can only be achieved by using MDP. His first publication on this subject dates back to 1998. It was the use of Kuraray Noritake’s PANAVIA, which did indeed contain MDP, which made it possible to achieve durable synthetic resin bonding to zirconia after sandblasting.

Sandblasting Dentists and dental technicians are apparently somewhat averse to sandblasting*, as evidenced by the extensive research conducted in an attempt to find an alternative. No such alternative has yet been found. Efforts have been made to fuse a silica layer onto the zirconia to improve bonding, but according to Kern, the results of this procedure – the Rocatec method, for example – have been disappointing. Nor is the silanisation of a zirconia restoration effective, because zirconia does not react to silan.

Using the new zirconia materials means that a thickness of only 0.4 to 0.8mm need be removed for a veneer in the incisal and cervical area, and only 0.5mm is required in the labial plane, which corresponds with the requirement to save tissue. For inlays, too, only 1mm is sufficient to achieve a durable result. If the inlay is extended to an onlay, 1mm is also sufficient for the area where the cusps are capped. For a full crown in the lateral parts, a 1mm space must be kept as a minimum, which thickness must also be maintained for the upright walls of the preparation.

Dentists who want to achieve the durable cementation of their zirconia restorations therefore have no other option than the purchase of a sandblasting device. Sandblasting can be carried out in a small cabin to prevent the surrounding area of the practice from being affected. Soft air abrasion is carried out at 0.5 bar, while tight air abrasion is performed at 2.5 bar. The exact pressure is not all that crucial to the adhesion of the zirconia, providing that it is between 0.5 and 2.5 bar**. Kern advises sandblasting at a pressure of 1 bar, so that the surface to be bonded becomes somewhat rougher without this being visible to the naked eye. Obviously, the part of the restoration that does not require bonding, such as the outside of a veneer or the dummy of an etching bridge, has to be protected from the effect of the abrasive grains. It is also advisable to apply a colorant (waterproof marker pen) to the area to be sandblasted prior to the operation.

Fixation A wide range of possibilities have already been suggested for the durable fixation of zirconia-based restorations. All of these options have also been researched, but according to Prof. Matthias Kern, there is no point in conducting further research into the best cementation procedure. This scientist and practitioner, who currently works at Kiel University, in Germany, has been involved in the adhesive cementation of zirconia for nearly twenty years. Based on his wide experience, Kern is convinced that three requirements have to be met to achieve the reliable cementation of zirconia. First of all, a

The colour disappears during sandblasting, making it easy to check that the entire adhesive surface has actually been abraded.

Sandblasting Sandblasting of zirconia oxide at a lower pressure is a requirement for an effective adhesion. The combination of sandblasting and MDP ensures both mechanical adhesion in the micro-roughness and chemical adhesion between zirconia dioxide and MDP. There is extensive research material to corroborate the effectiveness of this method.

* It had long been assumed that the tetragonal and/or cubic structure would relapse into a monoclinic state due to sandblasting, as a result of which fracturing would occur because of the associated expansion. Sandblasting with aluminium oxide particles of 50 micron as a maximum and a maximum air pressure of 2.5 bar does not, however, cause any damage. ** Airpressure is different from manufacturer‘s recommendation.

2 6

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE Adhesive monomer

PANAVIATM V5 FOR THE ADHESIVE FIXATION OF ZIRCONIA

The restoration surface can be cleaned using alcohol after the sandblasting process. This step is optional. If the alcohol becomes contaminated, for example, by saliva residues, the effect will be negated, because the sandblasted surface would be contaminated as well. The choice of the fixation procedure is relatively simple provided MDP is used. This adhesive monomer was developed in 1981 by Kuraray Noritake Dental to improve the adhesive strength to hydroxyapatite, and has proved its strength ever since. MDP is not present in the glass ionomer cements (GIC’s), which, because of their ease of use, are also sometimes used for the cementation of zirconia restorations. ‘Don’t!’ warns Kern. It is clear from all the studies that the composite cements containing MDP provide the most durable results. The oldest known cement from this category is PANAVIATM EX, which was introduced in 1983. The optimised PANAVIATM V5 was presented recently as the single cement for all cementation indications guaranteed to work according to a predictable procedure. All the cements and bondings produced by Kuraray Noritake contain MDP.

Achieving a reliable bonding to zirconia – it can be done. Read all about it in the preceding article. PANAVIATM V5 is the successful successor to both PANAVIATM F2.0 and CLEARFILTM ESTHETIC CEMENT. Thanks to its excellent adhesive bond with both dental tissue and all indirect materials, superior aesthetics, and unambiguous processing, PANAVIATM V5 is a popular bonding cement. PANAVIATM V5 provides a single cement for all cementation indications and features an unambiguous procedure.

Concise instructions for use 1

Possibly because Kern conducted his research in Maryland for two years, he has recorded remarkable results with adhesively cemented Maryland bridges (etching bridges). It has also become apparent that, most of the time, an adhesion bridge functions best with only one wing. For example, if a one-wing zirconia adhesion bridge is cemented using a cement containing MDP instead of a lateral upper incisive adhesive, such an adhesion bridge may remain in place for up to 20 years, to the satisfaction of both dentist and patient. This restoration, with its survival rate of 95.2% after five years, therefore qualifies as a permanent restoration. And the same goes for an onlay bridge made from zirconia.

Sandblast the zirconia surface to be bonded with aluminium oxide powder (30-50 μm) at low pressure, then clean the restoration in an ultrasound bath and allow it to dry. Apply CLEARFILTM CERAMIC PRIMER PLUS to the restoration surface, then proceed to Apply & Go. Dry the entire surface using a gentle air flow. Apply PANAVIATM V5 Tooth Primer to the element and leave it to take effect for 20 seconds. Dry the surface with air. Apply PANAVIATM V5 Paste to the restoration surface and position the restoration. Remove surplus cement and light-cure. Always take account of the self-curing time needed for opaque elements and the use of PANAVIATM V5 Opaque.

Sandblasting and MDP; the formula for the durable bonding of zirconia restorations. So bear in mind: MDP also stands for a Mega Durable Product.

Positioning After placement, remove excess cement using a gauze, a small brush, or something similar.

DANIELE RONDONI Owner of a dental laboratory in Savona

PROFESSOR MATTHIAS KERN Christian-Albrechts University

h en r y sc h e i n .c o m .a u

Applying the paste.

2 7

COSMETIC & RESTORATIVE

SINGLE SHADE RESTORATIONS WITH AQUACARE, CADCAM & BONE SURGERY

Stabilising complex cases with single shade composites One of the main indications for using a single shade strategy, is when shape primes over any other factor. Focusing on the shape, allows us to do more versatile construction techniques, uniform colour and a strong material thanks to less gaps or air bubbles.

much better the thickness, opacity and colour of the material that will be used. Remember to do this without letting teeth dehydrate. The success of these restorations resides on a proper retraction that a rubber dam clamp can perform much better that other retraction aids. This allows to improve the cervical contour and emergency profile in a very efficient way. In order to keep the old restoration, it has to be conditioned by sandblasting (29 micron, Aluminium Oxide, AquaCare, Velopex) as shown below.

Patient came to our attention after failed attempts with ortho and restorative therapy in other office. After the diagnostic stage, aesthetic planning was carried out.

After conditioning the old composite with sandblasting and the sound enamel surface with Orthophosphoric acid, a Universal Bonding system (Scotchbond Universal Plus, 3M) was applied for 20 seconds, rest for 20 seconds, blown air gently and polymerized perfectly.

A digital project was proposed to the patient. It highlighted the need of crown lengthening. Gingival parables were measured in the untouched model according to the project. Bone surgery was performed. Healing after 3 months, patient is ready for the restorative appointment.

Front wing technique was used for creating the cervical contour, emergency profile and tooth dimensions. A low stress, high polishing universal composite was used for the restoration (Filtek Universal Restorative, 3M,)

Colour selection was done with a direct mock-up, the same day of the restorative appointment. Same procedure was done in the tooth 2.1, this strategy, differently to the button try-in, simulates

See the full article

PROF JORDI MANUATA Marseille University

2 8

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

USER CASE STUDY BULK COMPOSITE FILL-UP

November 2014

In this case, a young patient was provided with a direct posterior tooth restoration using the dual-curing, medium-viscous bulk composite Fill-Up! (with antibacterial zinc oxide additive) and an approx. 2 mm covering layer of the established hybrid composite SYNERGY D6 (by COLTENE). Introduction Composite restorations in the posterior tooth region have for decades proven to be a suitable alternative to metallic fillings such as amalgam, which many patients refuse these days. During this time the material group of composites has been continuously improved. The new generations of bonding agents, less polymerisation shrinkage and greater abrasion resistance, together with modern layer techniques, have today become the standard in dental practice.

Nonetheless, composite restorations in the posterior region still remain quite time-consuming. To meet the needs of many dental practitioners for simplification, particularly with regard to the time-consuming layer technique in the less aesthetics-oriented posterior region, the dental industry has for some time now started developing a variety of bulk fill composites. To date there have been two groups, the bulk fill composites with low viscosity and the bulk fill materials with high viscosity. Fill-Up!, which is presented here, can be classified as a new third group of bulk fill materials with medium viscosity with good abrasion stability. The expression "bulk fill" actually implies “filling in a single step”. This means quick and simple application and finishing, less polymerisation stress and good durability at lower technique sensitivity with the known bonding agents, as well as adequate bonding to enamel and dentine. The maximum curing depth

Fig. 1: Initial situation: secondary caries underneath old composite filling on the first mandibular molar

Fig. 2: Removal of old filling under dental dam

Fig. 3: Cavity with applied matrix

Fig. 4: Determination of cavity depth using a scaled periodontal probe

Fig. 5: Conditioning of cavity with phosphoric acid (Etchant Gel S, COLTENE)

Fig. 6: Application of bond on enamel and dentine (ParaBond, COLTENE)

h en r y sc h e i n .c o m .a u

2 9

COSMETIC & RESTORATIVE of 4-5 mm remains a limiting factor with many bulk fill materials, both for low and high viscosity composites.

The material used demonstrates excellent flow behaviour here, which is extremely helpful, especially for deep Class II fillings.

However, the Fill-Up! material used here is a dualcuring bulk composite. This allows the application of layer thicknesses of more than 5 mm in a single step, without any impairment in curing of the entire increment.

An approx. 2 mm thick covering layer of hybrid composite, here SYNERGY D6, is not essential, but was chosen in this case for occlusal design purposes and improved aesthetics as well as approximal contact point design. This also reinforces the mechanical stability of the entire filling.

This is of an advantage in the case of approximal surfaces in the posterior region, for example, if deep root caries is also present in a Class II. Reliable chemical curing is assured after 3 minutes (including processing time), it is not essential to measure whether a layer thickness of between 4-5 mm can be attained. By using additional short lightcuring, the polymerisation process of the upper layers can be accelerated and the filling processed directly. Slight post-darkening is generally observed with chemically curing materials. With the Fill-Up! Universal material used here, the final shade is achieved after 24 h and is comparable to the shade VITATM A2/A3.

Highly viscous bulk fill materials with a limited range of shades can be used for modelling, but the poorer adaptation behaviour at this viscosity can lead to the known problems of primary marginal gaps or air bubbles. Therefore, this material group is not the optimal solution per se. When performing a cover layer filling, it is possible to fill the cavity in two steps when using the Fill-Up! material applied here. This also represents clear savings in time compared with the usual 4-5 increments for conventional methacrylate-based hybrid composites and the corresponding longer and additive exposure times. The S.P.E.C 3 polymerisation lamp by COLTENE used here, takes 5 seconds at a performance setting of 1600 mW/cm2.

Only few patients demand highly aesthetical restorations in the poorly visible posterior region, so the disadvantage of different shaded fillings can be ignored after the first molar in both the maxilla and the mandible. For example, this includes patients presenting in the dental practice for the replacement of old amalgam fillings or also patients who want shorter treatment sessions. This also applies to the treatment of children, which will not be addressed in this case study.

Add to this the manufacturer’s reference that the recommended exposure time should not be exceeded to keep the shrinking stress as low as possible. In addition, it is also recommended to adhere to the curing time of 2 minutes in case of very deep cavities (over 4-5 mm) to avoid adhesion of the material to the matrix.

Using the dual-curing Fill-Up! bulk composite it is possible to facilitate Class I and Class II fillings quickly and easily.

Fig. 7: Application of Fill-Up! (COLTENE)

Fig. 10: Final outcome, filling after 4 weeks

3 0

Fig. 8: Light polymerisation of Fill-Up! with S.P.E.C 3 lamp (COLTENE) for 5 s

Fig. 11: Final outcome, fillings mandibular premolar, opposite molar after 4 weeks

1 3 0 0

6 5

8 8

2 2

Fig. 9: Cavity filled with Fill-Up!, whereby approx. 2 mm of room were left occlusally for a covering layer of SYNERGY D6 (COLTENE).

COSMETIC & RESTORATIVE

Using Fill-Up! for Class II cavities The new Fill-Up! bulk composite lends itself for use on the young patient with approximal secondary caries on tooth 36 mesial (Figure 1). The cavity is prepared after drying with the dental dam (Elasti-Dam, COLTENE). Applying the known rules for the acid etching technique, Fill-Up! was quasi underfilled to approx. 2 mm below the preparation margin before applying the covering layer of SYNERGY D6. Finishing and polishing was performed with DIATECH products by COLTENE.

Conclusions Every time we want to use a good flowing composite for larger cavities in our practice, without having to accept the known disadvantages of shrinking stress, then the Fill-Up! bulk composite is an excellent complement to our present range of composite materials (for example, SYNERGY Flow or SYNERGY D6). The dual-curing principle is a major advantage compared with the existing thin-flowing bulk composites presently available on the market, for example, Filtek Bulk Fill by 3M ESPE. The conventional maximum layer thickness of 4-5 mm can certainly be exceeded without drawbacks in daily routine. A good restoration can also be ensured if the the increment lies in the so-called "light shadow" of the polymerisation lamp. The material properties described here can also prove useful when filling a root-treated tooth and result in quicker restoration of the tooth. With the Fill-Up! bulk composite by COLTENE, one can be assured that the dual-curing material is completely cured in every part of the filling after 3 minutes (including processing time). The offered product is convenient and simple to handle (i.e. due to the different diameters of the mixing tip attachments). In addition, the filling with bulk and hybrid composite represents a clear advantage in terms of time saved when compared with conventional filling methods consisting of several small increments. And finally, the application of a covering layer of SYNERGY D6 results in good aesthetics as well as contact point design.

Scan here to view the Fill-Up! range on our website

CHRISTOPH G. HÜSKENS HERRENWIESE 3 Dr. med. dent

CH-9306 Freidorf TG / Switzerland h en r y sc h e i n .c o m .a u

3 1

COSMETIC & RESTORATIVE

RESTORING ENDODONTICALLY TREATED TEETH A SIMPLIFIED TECHNIQUE

September 2009

As the deformation of the post closely resembles that of the cement - deflection to occlusal forces – it will be better at reducing the incidence of root fractures. This is the reason why the mechanical and adhesive properties of the cement are as important as those for posts (4).

Restoring endodontically treated teeth is one of the procedures that we regularly see in our dental offices. This type of situation - which represents a specific issue because the tooth structure is compromised - is currently one of the biggest challenges for the practitioner (1).

This long and complex restorative procedure has been reduced to a simplified technique by introducing fiber posts and materials with adhesivecementation properties that can perform like a core and also like a permanent cement for the final restoration. All-in-one systems for cementing the post, preparing the core and cementing the final restoration, such as ParaCore Automix 5ml Syringe System (Coltène/Whaledent), are excellent options for use with these procedures (Fig. 1).

When we find a tooth that has been restored with a post and core/crown, we understand that they are all made from different materials, but at the same time, they should all function as a one unit (2). Teeth restored with flexible fiber posts are at less risk to suffer from root fractures and have also exhibited longer life-spans than those restored with rigid materials (3).

3 2

Fig. 1: ParaCore Automix 5ml Syringe System (Coltène/Whaledent)

Fig. 2: Preoperative situation

Fig. 3: Radiographic evaluation

Fig. 4: ParaPost Fiber Lux (Coltène/Whaledent)

Fig. 5: Isolation using a rubber dam

Fig. 6: Preparation of the site for the post

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

Clinical case The patient presented with a coronal fracture in the buccal, lingual and distal aspects of the first lowerright premolar (Fig. 2). The first procedures are: a) diagnose and determine if the tooth can be restored, and b) its prognosis. The clinical and radiographic exams will allow us to make the correct decision. In this case, the tooth has already undergone root canal treatment (Fig. 3). The correct treatment is to restore the tooth with a fiber post and crown. The type and size of post will be determined by radiographic analysis, and we will always respect the principles of endodontic sealing. We decided to use the ParaPost Fiber Lux yellow post (Coltène/ Whaledent) (1.0mm) (Fig. 4). Since we will use an adhesive technique, we recommend the use of a rubber dam, since it not only improves the visibility, but also provides a dry and contaminant-free site (Fig. 5). Immediately after this, we clean and eliminate caries with the indicated drills - depending on the posts to be used - and prepare the site for the ParaPost Fiber Lux post (Coltène/Whaledent) (Fig. 6). Once the site has been prepared for the post and we have verified that the remaining gutta-percha is in the apical portion, we then place the post into the root canal (Fig. 7) and adjust the length of the post as needed.

In this case, we had to reduce the apical length of the post by 1 mm using a diamond bur (Fig. 8). Now, it is time to prepare the tooth with the ParaBond Non-Rinse Conditioner from the ParaCore Automix 5ml Intro Kit (Coltène/Whaledent) (Fig. 9 and 10). Message it for 30 seconds inside the root canal and on the crown, and dry it using air and paper points to eliminate any residual conditioner (Fig. 11). Once the root canal has been dried, but not dehydrated, the ParaBond Adhesive from the ParaCore Automix 5ml System (Coltène/Whaledent) should be applied (Fig. 12). Mix equal parts of liquid A+B. To allow better access into the canal, use a mini sponge to apply the mixed components for 30 seconds to all previously prepared structures (Fig. 13). The next step is to thin down the adhesive with air to eliminate the solvent before light curing for 20 seconds (Fig. 14). Now we are ready to cement the post by injecting the ParaCore Automix 5ml cement into the canal (Fig. 15) using an endodontic tip and placing the post in the correct position. We then remove any excess and light cure for the final 20 seconds (Fig. 16, 17 and 18). Following this, we proceed by re-building the core immediately and syringe the ParaCore Automix 5ml cement (Coltène/Whaledent) into the ParaForm (Coltène/Whaledent) matrix for cores. This will form the preliminary shape of the core. It is then placed on the tooth and light-cured again for 40 seconds (Fig. 19, 20 and 21).

Fig. 7: Trial seating of the ParaPost Fiber Lux post (Coltène/Whaledent)

Fig. 8: Adjusting the length of the post

Fig. 9: ParaBond Non-Rinse Conditioner

Fig. 10: Placement of the ParaBond Non-Rinse Conditioner (Coltène/Whaledent)

Fig. 11: Removal of the residual conditioner

Fig. 12: ParaBond Adhesive (Coltène/Whaledent)

h en r y sc h e i n .c o m .a u

3 3

COSMETIC & RESTORATIVE We can then proceed with preparing the core (Fig. 22), taking the impression and evaluating with x rays (Fig. 23). Once the final restoration has been verified and adjusted, we can cement it using the same ParaCore Automix 5ml cement (Coltène/Whaledent). We had previously used ParaBond Non-Rinse Conditioner

3 4

(Coltène/Whaledent) for 30 seconds (Fig. 24), and after drying we had placed the Adhesive ParaBond A+B (Coltène/Whaledent) for 30 seconds (Fig. 25). At this point, we can cement the restoration permanently by light curing for 20 seconds (Fig. 26) to create one homogenous unit comprising the fiber post, core, permanent cement and crown.

Fig. 13: Placement of the ParaBond Adhesive (Coltène/Whaledent)

Fig. 14: Thinning down the adhesive

Fig. 15: ParaCore Automix 5ml cement (Coltène/Whaledent)

Fig. 16: Injection of the ParaCore cement (Coltène/Whaledent)

Fig. 17: Placement of the post

Fig. 18: Light curing the cement

Fig. 19: Placement of the ParaCore cement (Coltène/Whaledent) in the ParaForm Coreformer matrix

Fig. 20: Matrix in place

Fig. 21: Light curing the core

Fig. 22: Final preparation

Fig. 23: Evaluation with X-rays

Fig. 24: Placement of the ParaBond Non-Rinse Conditioner

1 3 0 0

6 5

8 8

2 2

COSMETIC & RESTORATIVE

Thanks to the advances of this all-in-one system, we can now cement the fiber post with the same material that was used for building up the core and cementing the final restoration. The good prognosis that we had been looking for is now reality. The bonding and adhesion seen under a scanning electron microscope proves it (Fig. 27 and 28).

Fig. 25: Placement of the ParaBond Adhesive

Fig. 26: Final restoration

Fig. 27 and 28: Scanning electron microscope images showing the fiber Post cemented with ParaCore Automix 5ml cement

(Coltène/Whaledent). Photos are the courtesy of Dr. Enrique Kogan and Dr. Rodrigo Arias.

Conclusions As this technique is highly simplified, the probability of errors occurring is much lower: The ParaCore Automix 5ml all-in-one system (Coltène/Whaledent) provides us with an alternative that is fast and efficient for restoring teeth which have undergone endodontic treatment. Geirsson J., Sigurdsson.- Posts in Endodontically Treated Teeth. J Esthe. And Rest. Dent. Sep-Oct. 2003. 2. Pitel M., Hicks N.- Evolving technology in endodontic posts. Comp. of Cont. Educ. in Dent. January 2003. 3. Mannocci F., Ferrari M., Watson T.- Intermittent Loading of teeth restored using quartz fiber, carbon -quartz fiber and zirconium dioxide ceramic root canal posts. J. Adhes Dent. Jan 1999. 4 Baldissara P.- Mechanical Properties and in Vitro Evaluation (Chapter 5). In Ferrari M., Scotti R.- Fiber Posts. Characteristics and Clinical Applications. Masson. 2002. 1.

To view the Coltene Whaledent ParaCore range, please scan here

DR. ENRIQUE KOGAN & ALEJANDRO KOGAN B. Palmas 830-101, México D.F. 11000

h en r y sc h e i n .c o m .a u

3 5

PAIN CONTROL

PAIN MANAGEMENT PERCEPTION IS REALITY

What is Pain? To understand the nature of pain and treat it effectively, let’s look at the physical, emotional and psychological factors that determine how it is experienced by individuals.

Factors that influence the perception of pain

The psychology of pain and the consequences of dental anxiety

The way an individual perceives pain is the result of both physiological and physical factors. Pain is one of the body’s most important ways of communicating, and the way each person processes pain involves complex neural phenomena. Nerve cells detect potentially damaging stimuli and send a signal to the brain, which assesses the threat and coordinates a response.

When it comes to pain, psychological stimuli can have the same effect as physical stimuli. Scientific models of psychological pain make it to study it in an objective way. In one study (Eisenberger et al. 2003), subjects’ brains were scanned as they played an interactive video game. When they were excluded from the game, the reaction of distress in their brains was similar to that induced by a needle prick. Pain is more likely to be reported by people who are anxious and have past memories of painful experiences. Younger people and those with higher education levels also tend to report pain more often. Negative emotions can increase the perception of pain too.

Although the physical experience of pain is highly subjective, for most people pain originating in the head is very hard to ignore, especially dental pain. Tooth decay, sensitivity, abscesses and periodontal diseases are among the most common types of pain that prompt patients to see their dentist. Pain and emotions

What are the consequences? Research shows that neglecting dental care can lead to heart disease, stroke and diabetes¹. When they avoid treatment, people suffering from dental anxiety and dental phobia present a higher health risk. They also suffer financially, often incurring higher treatment costs by waiting rather than seeking care before complications set in.

Emotions greatly impact the experience of pain, and an individual’s emotional state while visiting a dentist is crucial. Such personal factors as memories of past experiences, age, gender, social and cultural influences, expectations and attitudes affect how each person interprets pain.

3 6

1 3 0 0

6 5

8 8

2 2

PAIN CONTROL

The dentist’s role is to understand the patient’s emotional state and to take this into account to deliver the best care for that individual.

How pain messages reach the brain: the gate control theory According to the gate control theory of pain (Melzack & Wall, 1965), a “gate” mechanism in the central nervous system opens and closes to let pain messages through to the brain, or not. As nerve signals are transmitted, it is therefore possible to amplify, reduce and block pain messages before they reach the brain where pain is processed and perceived. * Dentists can use this phenomenon to modulate the pain and to relax patients during treatment.

What can the dentist do? Dentists must keep in mind that “perception is reality” for patients experiencing dental pain. To reduce fear and stress, they can start by creating a reassuring environment. Keeping up to date on the most recent techniques for overcoming dental anxiety is also important. And simply explaining the physiology of pain to patients in simple terms can be helpful. ¹WebMD.com dental care and diabetes Source: https://www.septodontcorp.com/highlights/what-is-painperception-is-reality/

Want to discover what type of Pain Manager you are? TAKE THE TEST https://www.septodontcorp.com/technology-and-products/pain-management/take-the-test/

h en r y sc h e i n .c o m .a u

3 7

PAEDIATRIC SOLUTIONS

HOW TO DEAL WITH YOUNG PATIENT’S PAIN? COMPLEX ANSWER FOR SURE!

Options to manage young patient’s pain Successful procedural outcomes depend on effective pain management; it is especially relevant when providing treatment to children. Pain is the response to nociceptive stimuli. The response to a stimulus varies greatly from one child to another child. The delivery of quality dental treatment relies heavily on the ability to prevent and RELIEF pain.

understanding of the pharmacology of the local anesthetics and the specific techniques for children are critical in the successful use of the anesthesia. Along with the basic behavior management techniques and the use of local anesthesia, is the correct use of nitrous oxide (if available in your Country). Without any question, the key to successful use of nitrous is patient selection. The ideal pediatric patient is slightly anxious and old enough to wear the nasal hood.

Controlling pain is critical to a successful dental treatment. It was not too long ago that many in the dental and medical community doubted that children were susceptible for pain. Pediatric patients may not be able to provide a very detailed description of the pain, including the intensity. Fortunately, there are several pain scales that can be used with children to estimate the intensity and severity of the pain.

Treatment with Biomaterials The use of biomaterials is a recent and highly effective strategy to decrease pain, especially in the post-operative phase. Biodentine™ is a calciumsilicate based material that became commercially available in 2009. The material is specifically designed as a “dentin substitute”. The spectrum of applications of Biodentine™ is wide and includes endodontic repair, indirect pulp cap, direct pulp cap, liner and dentin replacement in restorative dentistry.

Different options to help with the pain are available to the dentists who provide care to children. These options include:

• • • • •

Behavioral management

The composition of Biodentine™ consists on a powder (tricalcium silicate, dicalcium silicate, calcium carbonate, oxide filler, iron oxide shade, and zirconium oxide) and a liquid (calcium chloride and hydrosoluble polymer). One of the main advantages of Biodentine™ is the setting time, which is around 9-12 minutes. There is a significant difference in the setting time compared with other similar cements (like MTA). The compression strength of Biodentine™ is similar to the dentin. The use of etch over Biodentine™ does not affect the compressive strength of the material. A critical factor of Biodentine™ is the porosity. Because of the low content of water of Biodentine™ the porosity of the material is lower compared with other materials.

The use of local anesthetics (like articaine) Nitrous oxide (if available in your country) Analgesics Bioactive dental materials like Biodentine™

Behavioural management, local anesthetics & Nitrous oxide The use of behavior management techniques when treating young patients is the key to pain control in the dental office. “Tell-Show-Do” is the core approach for behavior management. The correct use of local anesthesia is also a fundamental component in the algorithm to control pain in children. A good

3 8

1 3 0 0

6 5

8 8

2 2

PAEDIATRIC SOLUTIONS

This is a significant benefit when a perfect seal is mandatory, like in direct pulp cap treatment. The radiopacity of Biodentine™, thanks to the content of zirconium is ideal and allows the practitioner to visualize the material on the radiographs. The antibacterial property of Biodentine™ is attributed to the high pH of the material. The high alkalinity has inhibitory effect on the growth of microorganisms. The biocompatibility of Biodentine™ is outstanding and has been probed in multiple studies when the material is placed with fibroblasts from the pulp. According to the American Association of Endodontics, full pulpotomy involves the removal of the coronal portion of the vital pulp as a means of preserving the vitality of the remaining radicular portion. It may be performed as an emergency procedure for temporary relief of pain, and this is a critical advantage of Biodentine™ in front of other materials that can be placed in direct contact with the pulp. The presence of spontaneous or severe pre-operative pain does not always indicate that the pulp is not capable to repair. Vital pulp therapy with Biomaterials

Furthermore, Biodentine™ induces the formation of tertiary dentin synthesis with provides protection to the pulp. These two combine effects might be responsible for the ABSENCE of pain and hypersensitivity. Reducing inflammation & post-operative pain Another critical report found that the application of Biodentine™ reduces both TRPA1 pain receptor expression and function. More importantly, when applied on odontoblast-like cells, Biodentine™ decreases pro-inflammatory TNF-a secretion. This indicates that in addition to the roles of Biodentine™ mentioned in the first paragraph, its application onto the dentin-pulp reduces the inflammation and consequently the post-operative pain. References Malkondu O, Kazandag M, Kazazoglu E. A review on Biodentine®, a contemporary dentin replacement and repair material. Biomed Research International 2014. Kaur M, et al. MTA vs. Biodentine®: Review of literature with a comparative analysis. J Clin Diagn Res 2017; 11(8): 01-05 Imad A. Biodentine: from biochemical and bioactive properties to clinical applications. Giornale Italiano di Endodinzia 2016; 30: 81-88

Several recent clinical studies reported a successful medium to long term outcome of vital pulp therapy in teeth with PAIN, particularly young or immature teeth. The mechanisms of interaction of Biodentine™ with the dental hard tissues, explain, at least in part, the post-operatory pain control with BiodentineTM The material provides a micromechanical retention by infiltrating the dentin tubules.

JUAN F. YEPES DDS, MD, MPH, MS, DrPH, FDS RCS(Ed) Professor, Department of Pediatric Dentistry Indiana University School of Dentistry | Riley Hospital for Children

h en r y sc h e i n .c o m .a u

3 9

ENDODONTIC SOLUTIONS

EDGEENDO SOLUTIONS AN INTERVIEW WITH DR. CHARLES J. GOODIS

Introduction

What are the benefits of the EdgeEndo files and which endodontist will benefit mostly from these files?

Henry Schein has been offering the endodontic solutions portfolio of EdgeEndo®, one of the world’s largest NiTi rotary file suppliers, successfully for two years and has just enlarged this range by EdgeFile® X7, the number one selling EdgeEndo® NiTi system in the United States.

The patient of course wants a quick root canal procedure because any time you can reduce chair time, they appreciate. And the patient wants a precise root canal clean-up to get rid of the pain but preserve the tooth. Both is supported by the flexibility paired with the stability, our files provide and thus allow endodontists to perform an accurate and fast procedure. In addition, the reasonablypriced files make the treatment also more efficient in respect of costs.

EdgeEndo® is conducting business in 35 countries around the world. The company’s mission is to deliver high quality dental products and solutions at affordable prices which in turn benefits practitioners and patients everywhere.

How do you achieve the balance between offering high-quality endodontic products at low price?

US based Endodontist, Dr. Charles J. Goodis, Founder of EdgeEndo®, received his DDS from the University of Michigan, his GPR residency at the University of Minnesota, and his Endodontic residency at the University of Connecticut. Dr. Goodis has dedicated his career to constantly improving the root canal procedure. His findings led him to create more effective root canal instruments and procedures. He’s been working as an endodontist in Albuquerque, New Mexico, USA for 25 years.

Quality and value are paramount in importance at EdgeEndo. We have a very detailed quality system that allows us to produce a consistent, high quality product. Unfortunately, being an endodontist treating patients, I saw how high costs are and I thought to myself we can still offer a great product at a good price which provides value for the money. I think reasonable prices are important to a dental practice because as the dental fee structure changes in the US some dentists are making less money than they did before, and I believe offering a high-quality instrument at a lower price really helps dentists succeed.

Dr. Goodis, please tell us something about the company and the main products. My background in mechanical engineering and training in endodontics, as well as trying to help the patient and dentist do the best they can, inspired me to found EdgeEndo. Edge has been in the US market since 2012. In this short time, we have become one of the largest endo companies in the world. We now offer our products in 35 different countries.

Which is the most important instrument for root-canal preparation? How many files does one require as a rule? My personal preference is EdgeFile X7, it is super flexible, efficient and unbelievably strong. Each system varies somewhat. As a rule, most root canals can be completed with between 1 and 3 files.

Our main products are NiTi files that are heat-treated through our proprietary FireWire process. Our bestselling system is the EdgeFile X7. It’s one of the leading files used by endodontist in the US, Canada, New Zealand, Australia and many countries in the Middle East. EdgeTaper Platinum and EdgeOne Fire have also been very successful systems in these markets. EdgeEndo has been well received in the industry. In addition to files, we also sell a full assortment of accessory products including gutta percha and paper points.

4 0

1 3 0 0

We’ve simplified the technique for systems to help the dentist and eliminate waste. As an endodontist, I never used all of the different sizes in an assortment pack. With my file systems you can purchase the files needed and follow the techniques we’ve worked on with other dentists to develop.

6 5

8 8

2 2

ENDODONTIC SOLUTIONS

A common concern within root canal preparation is the cyclic fatigue. How resistant are the EdgeFiles (perhaps with reference to a clinical study)?

Another benefit of FireWire NiTi is it enables EdgeEndo files to not “bounce back”, preserving canal anatomy, and carefully follows the canal as they shape.

Our file systems are very resistant to cyclic fatigue. We’ve done both internal and 3rd party peer reviewed testing to ensure our files are more resistant. Dentist can refer to all of the published research on our site that back up our claim (https:// web.edgeendo.com/studies/).

How do you minimise the risk of file breakage with your files and are there any improved properties here compared to the files of other manufacturers?

What if I already have a working system and technique? Are the EdgeFiles compatible? Yes, I designed many systems to be an easy transition for the doctor to integrate Edge into their practice utilising the same technique and motor settings. If a dentist switched to Edge they can still use the gutta percha points, paper points and obturators they have in stock. Do customers need new motors for the application of the files? The motor currently being used by dentists should be able to work with our files. The only time we advise purchasing a new motor is when a dentist wants to use one of our reciprocating systems, such as EdgeOne Fire, which works in a reversereciprocating motion and can’t be used with a rotary motor.

Our files combine the attributes of being highly efficient and flexible, due to the proprietary FireWire heat treatment process, while being extremely safe and resistant to fracture. They are designed with a safe-unwinding feature. The files start unwinding before breaking. Unwinding signals to a practitioner that the file is fatigued and can break if they keep instrumenting with the file. This helps with stress and results in a more enjoyable procedure for the practitioner and patient. The patient is only in the chair for the time intended and this saves time and cost for both. Thank you, Dr. Goodis, for these interesting insights.

Watch Schein TV Episode Endodontic Innovations

The heat treatment process of the EdgeEndo files seems to play a big role in the quality and thus differs from files of other manufacturers. Can you describe the advantages to us? We spent a lot of time creating geometrically the best instruments out there. The proprietary FireWire heat-treatment process vastly improves the NiTi metallurgy, delivering excellent strength and flexibility, improving resistance to cyclic fatigue or in other words, reducing the chances our files will separate. DR. CHARLES GOODIS DDS, New Mexico, USA

h en r y sc h e i n .c o m .a u

4 1

ENDODONTIC SOLUTIONS

ENDODONTIC MOTORS BELLS & WHISTLES OR USEFUL FUNCTIONS?

ilt- in

patency

OGP)

There are many factors that contribute to predictable endodontics. Typically, a lot of focus is directed to the efficacy, safety and ease of use of the latest rotary NiTi file systems on the market and often there is less consideration afforded to the motors that drive these rotary systems. The objective of this article is to describe some of the latest features available in endodontic motors and consider if this technology has real value in practice.

Many of the currently available motors have preset speed and torque settings for popular file systems and sequences, however being able to customise the speed and torque settings to your own specific needs and then save them to the motor’s memory is a useful function. A conscious choice of settings rather than adopting a plug and play type approach is often a good idea, so you are always mindful of the appropriate speed, torque settings and safety features relevant to the size of the file and the stage of preparation.

ps to

mation.

ward

eleased

With the exception of reverse cutting file systems that require a motor with a reciprocating action, forward cutting rotary endodontic files can be used in all manufacturer’s endodontic motors. A light weight compact, cordless endodontic specific motor with a small handpiece head size, independent of the chair may provide easier access and greater tactile feedback.

pex

nience the first

In terms of each stage of canal preparation, the useful features of an endodontic motor include:

other

red by

1. Coronal Flaring & Straight line access Typically with crown-down preparation a larger taper file is used to create the coronal flare. As a general rule, for larger taper files the torque setting trigger can be set higher, but it is best to note the maximum speed and torque setting recommendations specific to the file system of choice. Setting the torque trigger at a specific value in Ncm allows torque reverse safety features to be employed. True torque reverse is one of the most important safety features in an endodontic motor. It ensures that when the torsional load on the file reaches the preset torque trigger, the motor will reverse the file, therefore releasing the torsional load on the file and reducing the risk of file fracture.

hing a

the

2 can

ciency,

ovide 4 2

Thinking ahead focused on life

Some of the newer motors allow selection of multiple torque settings, even up to a high 5 Ncm. The speed settings available on most motors will range between 150 and 1000rpm. Traditionally most rotary file systems have optimal cutting speed recommendations around the 300rpm mark, but it’s a benefit to have adjustable speed settings as some of the newer file systems have a higher optimal cutting speed of up around the 500rpm mark.

1 3 0 0

6 5

8 8

2 2

ENDODONTIC SOLUTIONS

2. Apex Location Some endodontic motors also have an integrated apex locator built into the motor, which for workflow purposes is a convenient addition. The function and accuracy of the apex locator built into the Morita Tri Auto ZX2 cordless motor is comparable to that of the Morita standalone apex locators such as the Root ZX. Although apex location features can be employed in these units in an “automatic” function whilst instrumenting the canal, using the apex location function independently and then using your working length to instrument independently may offer more control and accuracy.

3. Preparation of the Glide Path Traditionally glide path preparation has been achieved using stainless steel hand files. The advent of a patented glide path motion has enabled fatigue reducing, predictable and safer mechanical preparation of a glide path using .02 taper stainless steel or Ni-Ti rotary files. The OGP (Optimum Glide Path) mode in Morita’s Tri Auto ZX2 is a combination of a watch winding and balanced force motion. It is a constant action that replicates hand filing with a choice of 3 angles.

4. Canal shaping Using a Crown Down file sequence can reduce the risk of file fracture during canal shaping and apical sizing. The latest intelligent torque reverse motions can reduce file fatigue and assist with increasing efficiency and safety. (Pedulla,E et al.) OTR (Optimum Torque Reverse) is an Intelligent Torque Reverse that is employed when the torsional load on the file reaches the preset torque trigger. Instead of the file reversing out of the canals, with the OTR function the file only reverses 90 degrees then returns to forward cutting for 180 degrees and continues to progress down the canal. The file will repeat this action until the torsional load on the file is relieved. This allows the file to continue and safely progress down the canals, whilst decreasing the risk of instrument fracture.

Torque Down reduces the speed of the motor when the torsional load on the file is nearing the preset torque trigger. This is a useful feature as it gives you feedback and awareness of the stresses on the files, as well as slowing the rotational speed down to reduce the risk of instrument fracture. There are definite advantages to the latest advances in endodontic motors that potentially increase endodontic preparation predictability, safety and efficiency. Purchasing endodontic motors manufactured by reputable dental equipment manufacturers who will offer support and education is recommended. Pedulla E, Corsentino G, Ambu E, Rovai F, Campedelli F,Rapisarda S,La Rosa GR, Rapisarda E,Grandini S. Influence of continuous rotation or reciprocation of Optimum Torque Reverse motion on cyclic fatigue resistance of nickel-titanium rotary instruments. Int Endo J.May;51(5) 522-528.Doi:10.1111/iej.127689. Epub 2017 Apr 25.

DR. JEFF WARD BDS, MDSc, GradDipClinDent, MRACDS(Endo), FPFA Melbourne, Australia

h en r y sc h e i n .c o m .a u

4 3

ENDODONTIC SOLUTIONS

KOMET PROCODILE FAST CUTTING BY NATURE

With its completely revised file design, Procodile is a totally new species in the kingdom of root canal preparation. The innovative, variably-tapered file core makes Procodile noticeably more efficient and flexible and, therefore, ideally suited for the perfect shaping of the root canal and a high-quality preparation. Procodile can be distinguished from all other files at first glance by its unmistakable green colored ring. Hungry: Fast and efficient substance removal. Thanks to the innovative, variably-tapered file core, the chip space of the Procodile files is increased by up to 12 %*. Infected tissue is removed even more efficiently from the root canal thereby allowing for optimum preparation time. Flexible: Optimum preparation even of curved root canals. Thanks to its variably-tapered core and double-S cross section, the intelligent design of this file offers up to 44 % more flexibility. For this reason, even curved root canals can be prepared in complete safety without alterations of the shape.

Large chip space for perfect evacuation of debris

+44%

Reference product

Adapted instrument core for great flexibility.

* Compared to R6 ReziFlow instruments

Improved flexibility Procodile compared to R6 ReziFlow, based on in-house tests. Supporting data are available.

Fracture-resistant for greater patient safety Compared to other reciprocating file systems, Procodile is up to 120 % more resistant to cyclic fatigue. This decreases the risk of fatigue fracture and increases the safety of the patient. The single-use instruments are supplied in sterile packaging to reduce the risk of possible cross-contamination.

Procodile

Reference product

Procodile

Up to 120% safer

A new movement, adaptable in the EndoPilot Designed for work in all commonly used reciprocating endo motors for an easy-to-achieve and safe performance. That’s not all: Procodile files now perform a new, patented motion in the EndoPilot: Suitable for use in both straightforward and more complex canal anatomies, the intelligent ReFlex movement unites the advantages of rotary and reciprocating motions. Resistance to cyclic fatigue Procodile files compared to leading competitors, based on in-house tests. Supporting data is available.

4 4

1 3 0 0

6 5

8 8

2 2

ENDODONTIC SOLUTIONS

PREPARATION OF A DISTAL MOLAR WITH S-SHAPED ROOT CANALS

“Due to the limited interocclusal space, the pre- bent EDM files were the only files that would fit in the limited work space.” Dr. Sam Alborz Diagnosis Patient with chief complaint of pain in the lower left mandible (irreversible pulpitis with symptomatic apical periodontitis).

Challenge Mesial roots of tooth #18 (Universal Numbering System) with s-shaped canal system, significant faciolingual curvature of the mesial roots, not shown on radiograph. Narrowed workspace caused by servere class II skeletal relationship.

Treatment

User Benefits Convenient for use in narrowed work space. Due to the innovative manufacturing process Hyflex EDM files are extremely flexible and pre-bendable. Fast and reliable results using a reduced number of files. Preparation with just one universal EDM file size 25 is totally sufficient for the mesials – adding one 40/.04 for the distal. Safe operation due to centered canal preparation Controlled memory effect, allowing optimal preparation in the center of the canal without any transportation.

Conclusion HyFlex EDM Files are ideally suitable for preparation of hard to reach distal molars. Due to their controlled memory effect, HyFlex Files are pre-bendable and highly resistant to cyclic fatigue and file separation.

Treatment with a traditional NiTi 21 mm rotary instrument was not possible due to the insufficient interocclusal space. Preparation made possible by pre-bending EDM Onefile. See the case report

HyFlex EDM Onefile 25/~

Pre-op

Post-op DR. SAM ALBORZ USA: From a Distal, Roots International No 3, 2016, p 22-25 h en r y sc h e i n .c o m .a u

4 5

PRACTICE MANAGEMENT SOLUTIONS

GROW YOUR DENTAL PRACTICE WITH ONLINE BOOKINGS

So many parts of our lives are conducted online these days (for better or worse) and it’s important for dental practices to stay on top of customer preferences. Of course, visiting the dentist for a check-up will always require face-to-face contact. But that doesn’t mean you should neglect other elements of your business that could easily be managed online. We spoke with Emma Woods, Henry Schein One’s Business Development Specialist for New Zealand, to gather her expert tips for businesses looking to establish or enhance their online booking systems.

Logistically, how does EXACT software work? What if a practice doesn’t want to make their appointment book visible for everyone to see? This is a frequent cause of hesitation, as not everyone wants to show customers (or potential competitors!) how busy they are - or not!

Visiting the dentist is not something that can be done online, so why should dental practices care about improving their online systems?

But dental practices need not fear that their appointment book is visible for all to see. They have full control over which appointment slots are made available and are visible to patients looking to book.

We need to think beyond the actual event of visiting the dentist. How do patients make appointments in the first place? The current online activity of people, fuelled by the increase in the use of smartphones and tablets, sees us spending more time than ever connected to internet-enabling devices.

If a practice came to you for a business review but was reluctant to change their systems, what would you tell them?

Many people prefer the convenience of making bookings - including dental check-ups - online. Some research indicates that up to 40% of people say they prefer to conduct transactions over the internet, rather than on the phone or face-to-face. Practices should make that possible, even easy, for them to do so with an online booking system.

For those practices with an online booking facility in place, 47% of the total online appointments made are booked outside of business hours. This highlights the need for patients to have the flexibility to book appointments at their convenience. Take advantage of our complementary business reviews for tailored expert advice.

What systems have you found to be most helpful to practices that want to add an online booking system?

If you need help reviewing your practice performance, book a complimentary business review online: https://henryscheinone.com.au/ businessreview or by calling 1300 889 668.

Online booking is an integrated part of EXACT dental software. It allows patients to quickly and easily make appointments online whether they are at work, travelling or simply in the comfort of their own home.

4 6

1 3 0 0

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

AUTOMATIC CYCLE TRACKING WITH MOCOM’S DATASTER

The latest release of the ADA’s guidelines for Infection Prevention and control, in Section D. Instrument reprocessing, 8.

Maintenance and testing, talks about the requirement of Monitoring Sterilisation cycles. For Steam Sterilisation, time, temperature, and pressure must be measured with continuous, automatic, permanent monitoring. This data must also be recorded in either hard copy or electronic format and needs to be retained for a minimum of 7 years. Printouts generated by thermal printers tend to fade with time and become illegible, so these need to be transferred into digital format to give a stable record. Ideally you would want a Steriliser that has the ability to capture Data digitally on a USB or to connect direct to a computer and download cycle Data automatically. That’s where Mocom and the Dataster automatic cycle data capturing software come in to play. This approach also overcomes functional issues with memory cards.

Dataster is a PC based software that comes free with each Mocom Steriliser. It is supplied on the included USB key and the installation process is quick and easy. The software connects to the Steriliser via the local network once the Steriliser is also connected using it’s included Wi-Fi or Ethernet capability. Once the connection is established, Dataster automatically copies all available cycle data in PDF format into a selected folder on the PC, thus avoiding any manual process to download cycle data. Dataster periodically scans connected Sterilisers and downloads any new cycle data found since the last scan. The Steriliser can operate normally even while Dataster works in the background. As the cycle Data is saved in PDF format it is easily opened and read. It can also be printed from a standard printer if required without the need of additional software.

References: 1. Australian Dental Association Inc. ADA Guidelines for Infection Control 4th Edition (2021) JIM OWEN Sales Relationship Manager Mocom Australia h en r y sc h e i n .c o m .a u

4 7

INFECTION CONTROL SOLUTIONS

INFECTION CONTROL GUIDELINES INFECTION CONTROL SOLUTIONS

Welcome to the Infection Control segment of Dental Solutions. Thank you for all who have

Recently the Australian Dental Association released the new Infection Control Guidelines 4th Edition (ICG4). Keeping in theme with this release, we have brought to you some valuable information from our key suppliers and how their products relate back to some of the wording in the new ICG4.

read our IC Section in Dental Solutions to date, it’s been another exciting year in infection control and the environment is forever changing.

� CONFIDENTIAL

QUICK MONTHLY VIDEOS DELIVERING CLARITY ON IMPORTANT INFECTION CONTROL TOPICS

IC Confidential was created to reach out to customers via a free webinar to demystify some popular infection control questions.

We partner products with infection control protocols in order to help demonstrate the how to the why with these questions.

Presented by Emma Jones CICP-P

A big thank you to our valued viewers for attending the IC Confidential Episodes, we have now successfully completed the years’ topics and have ended with an overview of the new ICG4. Continued relevant education is crucial for team development, particularly in infection control. This landscape of infection control and prevention is changing so dramatically and IC Confidential has brought key topics and hopefully cleared up some of the uncertainty practices are often left pondering about.

For those that missed the topics, here is our overview of the year that was: Ultrasonic Bath Performance Surface Management Correct Packaging Techniques Are your waterlines safe? When did you last shock treat your dental chair? Instrument Reprocessing & Avoiding Sharps Risk Safe & Effective Suction Cleaning Autoclave audit ready - are you tracking correctly? New ADA Guidelines for Infection Control Part I New ADA Guidelines for Infection Control Part II

IC Confidential is always available on demand, so feel free to register and register again to review these episodes.

Scan this QR code to view all episodes of IC Confidential EMMA JONES CICP-P Infection Control Category Manager

4 8

1 3 0 0

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

NEW GUIDELINES AND NEW WATER LINE QUALITY PROTOCOLS

The 4th edition release of the ADA Guidelines for infection control has a much larger section and better clarity around waterline maintenance and guidance on what practices should do in order to keep waterlines safe for their patients and staff. The context is mostly the same but there are elaborated points on ‘sanitising treatments’ i.e. shock treatments. There’s no doubt that dental chairs across the country in the last 2 years have seen periods of none use and reduced operation due to the lockdowns of Covid-19. When a dental chair is left stagnant, they become grossly contaminated with biofilm. This happens regardless of lockdowns in business as usual terms, but the growth typically forms over longer periods. So, how do you know the status of your waterlines? The key is to TEST, if you don’t test your waterlines how do you if you comply and how do you know if they are safe? There is a common misconception that if the water isn’t ingested then there isn’t a risk, this is wrong. Think about the instruments we use and the aerosols we create, if we aerosol these microorganisms and breathe them in then the health implications can be significant. And most of all wouldn’t you want good quality water going into your patients’ mouths?

Henry Schein has the perfect partner who offer END to END waterline solutions. Dentisan is a UK company that has led the market there since 2009. They have a very safe but effective shock treatment called Bioclear Kit. Unlike some shock treatments who have scary PH values, Dentisan Bioclear Kit is PH7 and is derived from the same products that we use to treat wounds. You know when you use Bioclear as part of your sanitising step that it’s gentle on your chair and your staff. Dentisan offer it all from water test dip slides, daily treatment of waterlines via a solution, periodic shock treatment and they even have a tablet to shock treat your water bottle. Here is the full range and remember: Test > Treat > Repeat

QD-DS026 Dentisan Bioclear Dip Slides 10 slides Water Test

QD-DS025200 Dentisan Bioclear Kit 12 Pack x 200ml bottle shock treatment

Here are some key segments from the ADA Guidelines of Infection Control 4th Edition on this topic: “The number of bacteria in water used as a coolant/ irrigant for non-surgical dental procedures should be less than 200 CFU/mL since this is a widely used international limit for safe water for medical applications” “When high counts are found, the waterlines will need to undergo additional sanitising treatments (also called shock treatments) to remove biofilms and bring the bacterial levels back to within an acceptable range”. “After sanitising, test water levels more frequently (e.g. every 3 months)”

QD-DS0241 Dentisan Bioclear Daily 1 litre

QD-DS290 Dentisan Dentichlor Tablet 200 tablet water bottle disinfectant

Scan here to view the Dentisan Range on our website

References 1. Australian Dental Association Inc. ADA Guidelines for Infection Control 4th Edition (2021)

h en r y sc h e i n .c o m .a u

4 9

INFECTION CONTROL SOLUTIONS

REQUIREMENTS FOR MONITORING MY STERILISER OUTLINED FROM NEW ADA INFECTION CONTROL GUIDELINES

With the release of the latest edition of the ADA Infection Control Guidelines, you might be wondering whether there are any changes in the requirements for monitoring the steriliser/s in your practice.

Back in 1963, the most common items to be sterilised were items like fenestrated drapes and simple solid instruments. With the introduction of minimally invasive surgical (MIS) instruments we needed a way to ensure our sterilisers were also capable of sterilising hollow, more complex instruments - because it is far harder to achieve air removal and steam penetration in a hollow instrument (such as hand pieces and burs) than it is for porous items like a stack of fenestrated drapes or even gauze. This led to the introduction of the “hollow load test” (a.k.a “helix test”) in the standard EN 867-5. While EN 867-5 is for performance testing of small sterilisers, the hollow load test it defined was also added as a test for large steam sterilisers, in accordance with the need to simulate the challenge of hollow items.

The requirements for monitoring your steriliser remain unchanged. After your leak rate tests (daily or weekly), you must conduct one daily performance test to ensure your steriliser is capable of air removal and steam penetration so that we know we can adequately sterilise our instruments (and other items). All pre-vacuum steam sterilisers, regardless of their size – whether they’re a small benchtop steriliser in a dental practice or a large steriliser in a hospital sterilising department – operate the same way. And all sterilisers are subject to potential faults and as such we must ensure we test our sterilisers to ensure they can meet a standardised set of requirements.

The new ADA Guidelines have simplified requirements in a flow chart on page 42. We need to understand that “Bowie and Dick Test” is just terminology for the mandatory daily performance test, so whether you choose to call your daily test a “Bowie and Dick Test” or a “Bowie and Dick air removal test” or a “Helix Test” or an “air removal and steam penetration test,” it is adequate to use the GKE Orange Process Challenge Device (PCD) (meeting with EN 867-5) for the daily test you do in your steriliser.

There is sometimes confusion about whether a “Bowie and Dick Test” or a “Helix Test” or a “Daily Air Removal and Steam Penetration Test” must be done in a benchtop steriliser, and which should be done when depending on the items to be sterilised afterwards. It is important to understand that all of the above tests are the same by definition – a test conducted in an empty chamber to test the performance of the steriliser – i.e. to ensure it is capable of air removal and steam penetration.

We do not need to use a product defined as a “Bowie and Dick Test” in a small steam steriliser because the standard for small steam sterilisers (EN 13060) refers to the Type Test in EN 867-5.

Historically, Bowie and Dick Tests (first developed in 1963) were designed to be equivalent in challenge to that of porous loads in large sterilisers.

5 0

1 3 0 0

Don’t worry if your steriliser programs say “Bowie and Dick Test” or “Helix Test” – you can be confident in knowing that if you run the GKE Orange PCD in either program, you are doing the right thing.

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

You only need to do one of these programs as your daily functionality check. Because we know that hollow items are harder to sterilise than solid and porous items, if our steriliser can pass the GKE Orange PCD which tests to a hollow level, then we know that the steriliser can also sterilise items like gauze, drapes and cotton rolls. If we look at the standard for small steam sterilisers – EN 13060 – it only asks us to do the Type Test to EN 867-5, not a Bowie and Dick Test in accordance with ISO 11140 Part 4 as well. GKE Australia have devices available that are classified as “Bowie and Dick Tests,” but these devices are only sold to facilities with large steam sterilisers (such as hospitals) because that is what the standards require. The GKE Orange PCD is the right solution for you, your B Type benchtop steriliser and your dental practice, to ensure your steriliser performs according to the relevant standards.

Routine Monitoring Routine monitoring is something every facility sterilising instruments should consider as part of their risk assessment, regardless of whether their steriliser has an air detector. We must ask ourselves, what happens if we do our daily performance test today and it passes, but we do it again tomorrow and it fails, identifying a fault with the steriliser? Routine monitoring is also a mandatory requirement in the ISO Standard 17665-1:2006 where it says in section 10.1 “Routine monitoring and control shall be performed on each operating cycle.” Why should I pay attention to a standard that isn’t an Australian Standard? Our Australian Standards for the reprocessing of reusable medical devices in healthcare facilities (AS/NZS 4187 and AS/NZS 4815 – soon to be amalgamated into the one standard) are derived from International and European Standards (ISO and EN). You can see a list of “normative references” listed in AS/NZS 4187:2014 where all the mentioned standards above are listed.

Scan here to view the GKE Orange PCD Helix B&D Test on our website GK-F200-026 GKE Orange PCD Helix B&D test EN867-5 Complaint

LAUREN KONTUS BSC(ENVSC) Sales and Contracts Manager GKE Australia h en r y sc h e i n .c o m .a u

5 1

INFECTION CONTROL SOLUTIONS

MANAGING SURFACES WITH DISINFECTANTS KEY POINTS FROM THE NEW ADA GUIDELINES

The new Infection Control Guidelines from the ADA have covered some key points relating to surface management and the use of disinfectants.

“Working surfaces in the contaminated zone must be cleaned after every patient by wiping the surface with a product based on a pH neutral or mildly alkaline detergent, which may be combined with or followed by a disinfectant, according to a risk assessment or public health advice. Such environmental cleaning products should be approved by the TGA and included on the ARTG as Class 1 Medical Devices” (page 28 ADA Guidelines for Infection Control 4th Edition).

Previously there wasn’t much written on the use of disinfectants due to dental mostly operating under standard precautions and therefore only the need to disinfectant when operating under transmissionbased precautions or for blood splatter. Whilst this is still the case, the new ICG4 has elaborated on this point and the various types of disinfectants as per the TGA.

The Henry Schein branded Disinfectant wipe is made here in Australia and has been tested to be effective on killing the Covid-19 virus on surfaces within 2 minutes. It’s now available in refills as well to help reduce plastic wastage, so make sure you reuse your canisters.

“In times of greater risk, such as pandemics, use a two-step approach with both detergent and disinfectant (two separate wiping steps). Alternatively, perform two cycles of wiping down using a product that has combined a detergent with a disinfectant” (page 27 ADA Guidelines for Infection Control 4th Edition).

HS-5722626 SURFACE Disinfectant Wipes Hospital Grade 1 80 Tub

HS-5722627 SURFACE Disinfectant Wipes Hospital Grade 180 Refills

Scan here to view the Henry Schein Wipes Range on our website

Scan here to watch IC Confidential Episode 2 Surface Management

References: 1. Australian Dental Association Inc. ADA Guidelines for Infection Control 4th Edition (2021)

5 2

1 3 0 0

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

THE USE OF BARRIERS FOR INTRA ORAL RADIOGRAPHY

Recently Henry Schein has released high quality disposable barrier sleeves for intra oral phosphor plates. These barriers are widely

compatible across brands of PSP Scanners and suit machines that require horizontal loading | vertical loading | plates that require cardboard sleeves. Each practice seems to differ slightly with their protocols on how to handle and decontaminate these barriers. You must ensure there is no cross contamination that occurs either by handling of developing the plates or contaminating the PSP unit itself.

When looking to the ADA Infection Control Guidelines it clearly states some key steps on the handling and decontamination: “Following exposure of the radiograph, dry the film packet with a paper towel to remove blood or excess saliva before placing it in a container (such as a disposable cup) for transport to the developing area, where it will be decontaminated. Use protective barriers on developing equipment where possible” (page 54 ADA Guidelines for Infection Control 4th Edition).

Scan here to view the Maxi-Gard Range on our website References: 1. Australian Dental Association Inc. ADA Guidelines for Infection Control 4th Edition (2021)

h en r y sc h e i n .c o m .a u

5 3

INFECTION CONTROL SOLUTIONS

PICKING THE RIGHT DISINFECTANT FOR YOUR PRACTICE NOT ALL DISINFECTANTS ARE MADE EQUAL

The COVID-19 pandemic has affected every aspect of our lives in ways nobody could have expected. For the public, this

Disinfectants

Standard and Transmission-Based Precautions

With so many disinfectant products available on the market, choosing a disinfectant that suits a facility’s needs and meets current infection control guideline requirements can be a daunting task. To make this process easier, experts in infection prevention have outlined a few key criteria to keep in mind:

A disinfectant is defined as a “substance that is recommended by its manufacturer for application to an inanimate object to kill microorganisms”1. In the previous ADA Guidelines, disinfectants’ applications were only mentioned briefly for use in cold high-level chemical disinfection (e.g., glutaraldehyde) or on dental prosthetics. Now, the ADA Guidelines include a listing of the different disinfectant categories, as regulated by the TGA (Therapeutic Goods Administration). This includes disinfectants manufactured for use on medical devices as well as surfaces.

outbreak has heightened awareness around the dangers and spread of viruses. For health care workers around the world, it has reinforced the importance of properly completing and monitoring standard infection control protocols. In Australia, the ADA (Australian Dental Association) has recently published the fourth and newest edition of its Guidelines for Infection Prevention and Control incorporating key lessons learned from the pandemic. The Guidelines for Infection Prevention and Control address both standard precautions aimed at reducing the risk of transmission of infection using basic processes as well as certain transmissionbased precautions which are applied in the presence of suspected or confirmed infectious agents. With regards to environmental cleaning, the ADA indicates that a two-step approach can be applied to clean and disinfect clinical contact surfaces in times of greater risk such as pandemics. This can be done using two different methods: 1. Cleaning the surfaces with a detergent and then wiping it down with a disinfectant. 2. Wiping the surface down twice with a one-step product containing both detergent and disinfectant properties; for e.g., using a cleaner-disinfectant wipe product once and then going over the surface a second time with a fresh wipe of the product.

5 4

1 3 0 0

6 5

•

Compliance – All disinfectants used in a health-care setting must be TGA-registered or TGA-listed and included in the ARTG (Australian Register of Therapeutic Goods);

•

Kill claims – The ideal disinfectant should be highly effective against a broad spectrum of relevant pathogens, in accordance with TGA requirements;

•

Contact time and wettability – The ideal disinfectant should kill pathogens in a rapid nd realistic contact time, and should evenly wet the surface for the length of the contact time;

•

Safety – The ideal disinfectant should be non-toxic and non-irritating when used as directed, and should not carry occupational health risks;

•

Ease of use – The ideal disinfectant should be easy to use, to eliminate user error and improve compliance.

8 8

2 2

INFECTION CONTROL SOLUTIONS

Disinfectant Product Safety Cleaning and disinfecting products have emerged as a significant risk for users and occupants, as chemicals commonly used have been associated health and safety hazards2. Research has indicated the potential of disinfectant products to contribute to respiratory hazards including the onset of asthma or exacerbation of existing asthma. Disinfectant products should be non-toxic and should not cause any harm to users, patients, and visitors. Facilities should choose disinfectants with the lowest toxicity and flammability ratings. OPTIM Blue Cleaner-Disinfectant Wipes and Liquid have been formulated to be non-toxic, non-irritating and non-respiratory sensitizing.

OPTIM Blue products are not classified under any GHS hazard class, meaning there are no physical or health hazards associated with OPTIM nor do the products utilize any ingredients that are carcinogenic, mutagenic or have reproductive toxicity, giving user confidence that they won’t be harmed when using OPTIM according to the label directions. Not only is OPTIM a more responsible choice for patients and staff, but it is also more environmentally responsible. OPTIM’s active ingredient, hydrogen peroxide, readily degrades into water and oxygen, leaving no active or toxic residues behind. OPTIM Blue also rises to the challenge for the other key criteria for the selection of the ideal disinfectant: with a fast 3-minute broad-spectrum contact time against TB (mycobacteria), bacteria, viruses, and fungi, OPTIM Blue is one of the most effective cleaner & disinfectants in the market. OPTIM Blue’s unique formulation provides the perfect balance between safety and efficacy.

SCI-OPTAZBLUE 12 OPTIM Blue Wipes Tub of 160 for Cleaning and Disinfecting

Scan this QR Code to view the OPTIM Range on our website

References: 1. ADA, (2021). Guidelines for Infection Prevention and Control, Fourth Edition, (2021). Accessed September 2021 from https://www.ada.org.au/Dental-Professionals/Publications/Infection-Control/Guidelines-for-Infection-Control/Guidelines-for-Infection-Control-V4.aspx 2 . CDC, (2010). Acute Antimicrobial Pesticide-Related Illness Among Workers in Health-Care Facilities – California, Louisiana, Michigan, and Texas, 20022007. May 14, 2010/ 59(18);551- 556. Accessed September 2021 from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a2.htm

h en r y sc h e i n .c o m .a u

5 5

INFECTION CONTROL SOLUTIONS

STERILE SURGICAL GLOVE DONNING AND DOFFING

Personal protective equipment (PPE) acts as a barrier and plays a critical role in essential infection prevention and control principles, such as standard and transmission-based precautions. The recently published 4th Edition Australian Dental Association (ADA) Guidelines for Infection Control1 and its recommendations for PPE is underpinned by the National Health and Medical Research Council’s (NHMRC) 2019 Australian Guidelines for the Prevention and Control of Infection in Healthcare 2. With single use gloves the most frequently used PPE, medical examination gloves are continuously on the hands of dental professionals due to their exposure to blood and body fluids. For specific recommended dental procedures, sterile surgical gloves are part of a suite that makes up surgical aseptic techniques to reduce infection transmission risk when undertaking surgical or invasive dental procedures. Due to less frequency and therefore, experience, the correct practice when using sterile surgical gloves may not be as instinctive as examination gloves, although basic infection prevention principles still apply. Any recommended steps for aseptic or surgical technique, including donning and doffing sterile surgical gloves, are currently not available in the ADA Guidelines for Infection Control 1.They only currently recommend that new clinical dental staff undertake surgical technique and preparation training, including scrubbing, gowning and gloving. but does not provide a source for this training. There are two methods for donning sterile surgical gloves. Depending on the task and whether dental staff are wearing a sterile gown, will dictate the donning procedure. If a sterile gown is worn, then an ‘open donning’ technique is used where after hand antisepsis, the gloves are touched only by their folded cuffs with care not to touch the fingers of the gloves while donning.

Scan this QR code to watch a video on ‘How to Properly Remove Single-use Gloves'

5 6

1 3 0 0

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

If sterile surgical gowns are worn, recommended best practice is the ‘closed donning’ technique3 as recommended by the Australian College of Perioperative Nurses (ACORN), where fingers are kept inside the sleeves of the gown to eliminate potential hazards in the glove procedure and the aseptic field is maintained. The glove doffing or removal technique is critical to avoid contamination. If gowned, the surgical gown should be removed prior to gloves to ensure protection of the hands against contamination. Gloves are then removed with care given not to touch bare skin with contamination gloves. Gown and gloves are also sometimes removed in a single process.

GAMMEX® Non-Latex PI Hybrid COMING SOON • Polyisoprene and neoprene blend surgical glove delivers latex-like comfort and superior durability • Non-latex to eliminate the risk of natural rubber latex associated Type I allergy • Zinc 2-mercaptobenzothiazolefree (ZMBT-free), diphenylguanidine-free (DPG-free) and cetylpyridinium chloride-free (CPC-free) to minimise the risk of chemical Type IV allergies and sensitivities to these chemical accelerators

GAMMEX® Latex Textured COMING SOON • Superior textured grip for secure instrument handling with ideal thickness to optimise tactile sensitivity and protection • Effortless dry and damp donning as well as intraoperative changes

When removing just gloves: •

The gloved fingers should touch the glove material at the wrist of the other hand, slowly pulling it off inside out and then grasping the removed glove in the other gloved hand.

•

Then remove the other glove by placing the bare fingers under the cuff, without touch the outside of the glove, and slipping it off, turning it inside out and containing the first glove.

•

Gloves are then disposed of in the appropriate waste bin.

•

Perform hand hygiene immediately before touching anything else. Contamination can still occur while wearing gloves due to the possibility of glove microperforations or defects through which micro-organism can easily pass. Contamination can also easily occur following glove doffing, as noted by the World Health Organization (WHO),4 if not performed correctly.

Scan this QR code to view the Ansell Surgical Glove Range on our website GAMMEX® Latex • Enhances comfort and fit to help reduce hand fatigue with shaped finger pads to improve fingertip sensitivity and instrument handling • Additional cleaning processes to minimise the risk of developing natural rubber latex allergies and sensitivities

References 1. Australian Dental Association Inc. ADA Guidelines for Infection Control 4th Edition (2021) 2. National Health and Medical Research Council (NHMRC) Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) 3. Australian College of Operating Room Nurses. Standards for Perioperative Nursing in Australia 16th Edition (2020) 4. World Health Organization. Glove Use Information Leaflet (2009)

h en r y sc h e i n .c o m .a u

5 7

INFECTION CONTROL SOLUTIONS

IMS CASSETTES WRAPPING TECHNIQUES GUIDE

IMS™ CASSETTES

WRAPPING TECHNIQUES GUIDE

Ensure all instruments and cassettes are dry before packaging for sterilisation. After cleaning, critical and semicritical instruments should be inspected for remaining debris. Ensure all instruments and cassettes are dry before packaging for sterilization. After cleaning, critical and

An internal chemical indicator should be placed inside each instrument package prior to sterilisation. If the internal semicritical instruments should be inspected for remaining debris. indicator is not visible from outside the package, an external indicator should be affixed to the pack.

An internal chemical indicator should be placed inside each instrument package prior to sterilization. If the internal

indicator is not visible fromdate outside theif package, external indicator affixed to the pack. Packages should be labeled with the and, multiple an sterilisers are usedshould withinbethe facility, the steriliser used should also be Packages labeled. This simplifies retrieval processed items in caseare of used a sterilisation failure.the When packaging should be labeled with theof date and, if multiple sterilizers within the facility, sterilizer should also be labeled. This simplifies retrieval processed instruments andused cassettes, ensure packaging does not haveofopen gaps.items in case of a sterilization failure. When packaging instruments and cassettes, ensure packaging does not have open gaps.

Ensure the following requirements are fulfilled Ensure the following when wrapping cassettes:

Method 11 Standard Method StandardGift Gift

requirements are fulfilled

•

when FDA approved andwrapping suitable cassettes: for steam • FDA approved suitable forup steam sterilization (temperature and resistance resistance to at least 141sterilization °C /286(temperature °F, sufficient up to at least 141 °C /286 °F, sufficient steam permeability) steam permeability)

•

Sufficient protection ofprotection the instruments • Sufficient of the instruments and the sterilization and the sterilization packaging against packaging against mechanical mechanical damage

•

Regular maintenance according to the • Regular maintenance according to manufacturer’sthe instructions manufacturer’s instructions

damage

•

Wrap should used in accordance Wrap should• be used inbeaccordance with the recommendations with the recommendations of the of the following standards: following standards:

•

ANSI/AAMI ST79: GuideComprehensive to Steam Sterilization and Guide to Steam Sterilisation and Sterility Sterility Assurance in Health Care FacilitiesCare Facilities Assurance in Health

•

• CDC Guidelines for Infection CDC Guidelines for Infection Prevention Prevention in Dental Healthcare in Dental Healthcare Settings Settings

Method 22Hospital Method HospitalStyle Style

• ANSI/AAMI ST79: Comprehensive

Learn more about IMS™ Cassettes at Hu-Friedy.com/IMS Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | Hu-Friedy.com

Learn more about IMS™ Cassettes at Hu-Friedy.com/IMS Link

All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC its affiliates or related companies, unless otherwise noted. Marks not registered in all jurisdictions. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved. M8128/0521

https://henryschein.com.au/infection-control/steri-room/pouches-and-wraps/ ims-autoclave-wrap-for-large-cassettes-508x508mm-pk-500 Hu-Friedy, Crosstex and Palmero are now proud members of

How to Wrap Hospital Style

5 8

How to WrapHu-Friedy is now a proud member of Gift Style 1 3 0 0

6 5

8 8

2 2

INFECTION CONTROL SOLUTIONS

STERILISATION WRAP UPDATE

Sterilisation Wrap Update Whilst there are no specific changes to the use of sterilisation wrap in the new 4th edition of the ADA guidelines it is key to note and to point out storage and handling requirements of wrapped items.

Benefits of using the HuFriedy Group range of Wraps •

When storing wrapped items these must be stored in a dedicated space free from dust/contamination. It is also important to note they must ideally be stored in ‘enclosures’ due to risks of environmental contamination.

•

If we think about common storage in the sterilisation area for example, often times there is shelving left open and also in the surgery.

•

To ensure your contents are not affected you may want to consider doors / draws as a more suitable storage option. Reference – ADA Guidelines for Infection Prevention and Control 4th Edition 2021

• • •

•

Hu-Friedy sterilisation wrap is a wet formed, nonwoven fabric compromised of natural wood pulp bonded with resin binder. During manufacturing, the wrap components are bonded together by entangling their fibres of filaments mechanically, thermally, or chemically. This bonded web of materials creates what is called a tortuous path. During steam sterilisation, steam is able to enter the wrap due to the extreme pressure present, in order to sterilise the contents. Post sterilisation, the tortuous path created by the fibres prevents bacteria from entering. Visual representation of the path that a potential bacteria would have to take Hu-Friedy wrap material is not fully biodegradable. It is composed of majority wood pulp, but there is an added polymer that aids in bonding the wood fibres. There is a sustainability advantage in that the main component, wood pulp, is a fully renewable resource. Many other wraps are compromised completely of petrol/oil derived plastics, which have no sustainability

h en r y sc h e i n .c o m .a u

5 9

INSTRUMENT SOLUTIONS

DIAGNOSTIC INSTRUMENTS CHECKUP ENSURING YOUR MIRRORS, PROBES & EXPLORERS ARE IN TOP SHAPE

Think back: When was the last time you updated your diagnostic instrumentation?

By ensuring your diagnostic instruments are in top shape, you can help these returning patients get back on track and back to optimal dental health as quickly as possible.

A diagnostic instrument’s useful lifespan can extend for years. There may be probes and explorers in use right now in some dental offices that performed exceptionally well over time but are truly no longer in optimal condition to advance efficient and vital dental diagnoses.

How Often Should You Perform a Diagnostic Instrument Checkup? It’s always a good idea to regularly inspect all your instruments and other dental equipment for damage and defects. We recommend inspecting your diagnostic instruments at least once a year and after any incident that may inflict damage (such as dropping an instrument).

High-quality diagnostic instruments are indeed durable. But so are teeth, and you wouldn’t advise a patient to skip routine prophylaxis appointments simply because their teeth look and feel fine. The same logic applies to diagnostic instruments.

If your practice is currently using any diagnostic instruments that are over one year old, we suggest performing a thorough check-up on them immediately.

Regular checkups are as essential for maintaining an effective dental armamentarium as they are for maintaining oral health.

What to look for in a diagnostic instrument check Mirrors

Why diagnostic instrument quality matters

To diagnose a dental issue, you need to see it. A good mirror helps you do just that, providing a clear, detailed view of all intraoral surfaces, reflecting light into dark crevices, functioning as a retractor, and enabling transillumination.

Dental professionals like you depend on diagnostic instruments to help assess tooth decay, detect caries and calculus, explore hard-to-access areas, measure periodontal pockets, and, in general, form a complete picture of each patient’s oral health.

Over time and in everyday use, dental mirrors can get scratched. Sterilization in pouches, rather than cassettes, readily allows sharp instruments to bump into mirrors resulting in scratching of the reflective surface. Wrapping mirror heads in gauze can allow rough fibres to scratch the mirror surface. Drops and other accidents can cause scratches as well. Investing in an instrument management system like IMS™ Cassettes can provide optimal protection and advance the longevity of your mirror heads. Mirrors lose some of their reflectivity with each scratch, providing less light to work with along with incomplete or distorted images, all of which can compromise the diagnoses.

If your diagnostic instruments are not in good working order, the diagnoses may not be entirely accurate. And as you know, the results can include underdiagnosis, where crucial warning signs of disease are not recognized, or overdiagnosis, with potential overtreatment of asymptomatic conditions. Neither is optimal for you or your patients. As pandemic regulations loosen and vaccine distribution accelerates, a large number of patients may be returning to your office after having postponed professional dental care for a year or more. Many of them will have symptoms of periodontal disease, decay, and other issues that require immediate attention.

6 0

1 3 0 0

6 5

8 8

2 2

INSTRUMENT SOLUTIONS And, you’ll work harder using a scratched mirror as you’re apt to constantly reposition the mirror and refocus in order to try and get the best, clearest view. Mirror heads are easily replaceable – allowing you to readily have better visibility and efficiency. If your mirror heads are scratched, we recommend seeking out replacements that offer exceptional levels of brightness, clarity, and reflectivity. HuFriedy’s High Definition Mouth Mirrors are an excellent choice. They feature a proprietary coating that provides superior brilliance and colour for increased visibility in all dental procedures. In tests, these HD mirrors have demonstrated a 113% reflection factor and are 50% brighter than other front surface mirrors. HD mirrors come in single or double-sided versions and are scratch-resistant. Additionally, HD Black Line Mirrors feature a Diamond Like Carbon coating that reduces glare up to 80% when compared to the non-coated stainless-steel mirror head and handle for enhanced visual acuity.

Explorers Explorers, necessary in all procedural set-ups, are instruments for which tactile sensitivity is paramount as they are used to detect caries, detect calculus (especially on subgingival tooth surfaces), determine pocket characteristics, and inspect restorations. While seemingly delicate, a high-quality explorer is both strong and flexible. An explorer should be able to “spring back” to its original shape if, for example, the tip becomes stuck in an occlusal pit and requires extra force to remove. While several types of designs are common, such as the cowhorn, Shepherd’s hook, or TU17, all explorer technique focuses on using the last 1-2mm of the working end. Using a deformed or broken explorer may compromise tactile sensitivity, inhibit adaptation to tooth surfaces, and be uncomfortable for the patient – all affecting optimal diagnoses and favourable treatment outcomes.

Probes

Like mirrors and probes, explorers can be damaged, deformed or broken during instrument reprocessing and the best solution to ensure longevity is use of protective cassettes.

Probes are the workhorses of the diagnostic dental instrument world since they are used on nearly every patient to gather vital data for determining a diagnosis, such as periodontal pocket depth, attachment level, anatomy configuration, and gingival bleeding.

Explorer tips are particularly vulnerable during reprocessing. If they break, their finely-honed edges can transform into blunt surfaces that can be painful for patients.

Probe tips are tapered in order to provide optimal access to narrow pockets. However, thin probe ends can bend or even break by jostling against other instruments in sterilization pouches, improper placement in cassettes, or due to mishandling and accidents. Using a bent probe is like using a bent ruler; you won’t be able to get an accurate reading.

HuFriedyGroup explorers are handcrafted from Duraspond steel, a specially-blended metal alloy that provides flexibility and resilience for even the most precise diagnostic procedures.

Plan your diagnostic instrument checkup now

Among the most important features of a dental probe are the markings on the tips, which are finely calibrated for precise measurements. Qulix™ Probes have accurate, smoothly finished black markings which will not chip, flake, or fade. Rather than being laseretched, the markings are ingrained in the metal – providing for a long-lasting durable instrument. Alternatively, you might consider opting for resin probe tips which can provide superior visibility and are safe on restorations but do need routine replacement as the markings can fade over time. HuFriedyGroup offers Colorvue™ Probes, which feature vivid yellow tips with black markings for enhanced contrast to intraoral structures in both natural and implant dentition. The probe tips are safe for use with implants and feature a twist-on design for easy replacement of worn tips. Colorvue™ Markings will wear with normal use, and tips should be replaced about every 30 sterilization cycles.

We all know how frustrating it can be when patients push back routine dental visits until their problems are too big to ignore. The earlier you can help patients detect dental health issues, the easier it is to prevent minor conditions from becoming lifelong challenges. The same goes for your diagnostic instruments. Setting aside an hour or two now, and on a regular basis, to inspect your mirrors, probes and explorers will ensure that your instruments are in proper working condition, allowing you to provide the most comprehensive and accurate diagnoses and treatments for your patients. All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

h en r y sc h e i n .c o m .a u

6 1

HANDPIECE SOLUTIONS

AEROSOL DRAWBACK IN HANDPIECES CAN IT BE ELIMINATED?

The COVID-19 pandemic has awoken a sense of urgency and concern in the dental world. Dental practices and schools are changing the way they operate by enhancing their cross-contamination response. Many dental equipment manufacturers are moving to provide their customers with effective solutions to assist them respond to this new normal.

These can be present in your treatment unit and even in your handpiece or coupling. Usually, you will find multiple anti-retraction valves as fail-safes. Most major manufacturers, including Morita, include them within handpieces, couplings and the treatment unit. This technology has been around for a while and the ISO 7494-2 standard requires your treatment unit to include it” Mr Sleeman explained.

One of those solutions has been to reduce the propagation of aerosols during dental procedures. Consideration of contamination from retraction and suck back into the handpiece lines has also been a topic of heightened interest.

According to “Transmission routes of 2019-nCoV and controls in dental practice”, “high-speed dental handpieces without anti-retraction valves may aspirate and expel debris and fluids during the dental procedures. More importantly, the microbes, including bacteria and virus, may further contaminate the air and water tubes within the dental unit, and thus can potentially cause cross-infection.”

Here we discuss this with J Morita Manufacturing Corporation engineer, Mr David Sleeman to seek clarification on the difference between antiretraction and Zero-Drawback.

“Should retraction occur, you can still flush and disinfect your waterlines as needed, so we can say that the potential for cross-contamination here is relatively low” Mr Sleeman said.

Retraction versus drawback. What is the difference? There has been a lot of talk about anti-retraction and anti-suckback features but little clarification about what they are and how they work” Mr Sleeman said.Mr Sleeman further clarified that “Retraction is essentially related to water being pulled back into the system through the water lines. So, retraction is strictly related to fluids and debris within those fluids”

What is drawback and can we eliminate it? Zero-Drawback is the solution. When asked to explain what the term Zero-Drawback means (or zero-suckback as it is sometimes known), Mr Sleeman said, “Unlike retraction, drawback is related to the air lines. Aerosols, created during dental treatment, can be drawn back into the handpiece, your air lines and eventually into your treatment unit.

“Many manufacturers, including Morita, have already solved this problem by introducing anti-retraction valves throughout the system. One common type is called a duckbill valve which is held open by water pressure and clamps shut when the water stops which blocks any fluids from travelling back into the water lines.

6 2

1 3 0 0

When the drive air stops, the turbine continues to spin. This creates negative pressure in the system and begins to draw aerosols back into the system, kind of like a vacuum.

6 5

8 8

2 2

HANDPIECE SOLUTIONS

Morita TwinPower Highspeed Handpiece with Zero-Drawback and anti-retraction

Top tier brand with anti-retraction and drawback reduction technology. Reduction is not enough.

This is also known as suck back. This effect is cumulative. Each time you activate the drive air, the draw back forces any contaminates further into the handpiece, past the coupling and eventually into your air lines and your treatment unit.

According to “In vitro study of anti-suck-back ability by themselves on new high-speed air turbine handpieces”, some manufacturers will introduce a labyrinth system to reduce draw back, but these will not eliminate the drawback effect.

Keep in mind that you cannot disinfect and flush the air or exhaust lines of your treatment unit.

Only the Morita Zero-Drawback system was found to eliminate draw back through this study *

Many manufacturers will include a braking system to reduce the spinning motion of the turbine once the drive air stops. Terminology for these types of braking systems may vary but at Morita, we call it Quick Stop.”

Anti-Suckback Diffuser (ASSD) Exhaust tubing

References Ozawa T, Nakano M, Arai T. In vitro study of anti-suck-back ability by themselves on new high-speed air turbine handpieces. Dent Mater J. 2010;29(6):649-654. doi:10.4012/dmj.2010-008

Peng, X., Xu, X., Li, Y. et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 12, 9 (2020). https://doi.org/10.1038/ s41368-020-0075-9

“A quick stop braking system can help reduce draw back but not eliminate it. The turbine continues to rotate after the drive air stops and, like any braking system, we cannot force the turbine to stop instantaneously. It takes time and during that time, draw back is occurring. In addition, smaller handpiece head sizes create less inertial force which also contributes to reducing stopping times.” Mr Sleeman said.

Quan, Yingjun & Lim, Joong-Yeon & Kim, Kyoung-Nam & Kim, Yang-Soo. (2015). A testing methodology for suck-back behavior of high-speed air-turbine dental handpiece. Korean Journal of Dental Materials. 42. 10.14815/kjdm.2015.42.1.29.

Smaller head sizes or quick stop braking mechanisms will help stop the turbine faster and reduce the number of possible contaminants from being drawn back into the system. But reduction is not enough as the effect is cumulative, and even minor draw back can be pushed back into the exhaust lines and contaminate your system” Mr Sleeman emphasised.

See our Morita TwinPower Highspeed handpieces available in 5 models

h en r y sc h e i n .c o m .a u

6 3

EQUIPMENT SOLUTIONS

EXPANDING IN-HOUSE TECHNOLOGIES

Expanding in-house technologies and services with Planmeca

The work begins We worked with a design company to organise and complete the refurbishment. Our preferred local building company were responsible for the construction work.

Dr Ceri Owen-Roberts is the Principal of Elgin Park Dental Practice in Bristol, England. He has a particular interest in restorative dentistry and dental implants. In the following article, Dr Roberts explains how he came to equip his clinic with a Planmeca CBCT unit.

During this phase of the project, the main challenges faced were not unexpected. The nature of the old building meant that the walls were thick, solid stone, making them difficult to cut into. While the internal parts of the building didn’t require any planning permissions, even the smallest of changes to such an old building are always very involved.

With a focus on dental implants and oral surgery, I used to frequently refer my patients out to colleagues for CBCT scans. These are necessary for accurate diagnostics and treatment planning and offer greater visualisation than plain film. However, as my implant business grew, it was clear from the number of referrals being made that we would benefit from being able to perform CBCT scanning inhouse. The benefits wouldn’t only be financial either. In some cases, the ability to take a CBCT and get the results immediately, without sending the patient elsewhere first, can be a huge advantage. I therefore decided to introduce the technology into the practice.

It was a combination of design recommendations and my own market research that led me to select a CBCT machine from Planmeca. The Planmeca ProMax® 3D Max was one of the few scanners that was compact enough to fit into the small space we had available. I was also impressed with the quality and abilities of the software, which seemed to meet my needs and enable me to deliver the highest standard of treatment. Crucially, this CBCT achieved high image quality with the Planmeca Ultra Low Dose™ technology, encouraging a safe yet effective imaging procedure. In addition, the offer of excellent technical support bolstered my final decision.

Preparation for the project In preparation for the project, I did a lot of research into the technologies on the market. I was particularly interested in the radiation dosage of each piece of equipment and the quality of images produced. I also focused very much on the software that came with each CBCT machine. I often use guided implant surgical techniques so I was aware of the importance of finding software that would be intuitive to my needs. I already had experience using several different software systems and often found this to be the limiting factor on the efficiency and quality of dentistry I could deliver, even more so than the imaging technology itself.

6 4

1 3 0 0

The design company installed the CBCT while liaising with Planmeca very efficiently to ensure everything went smoothly. Planmeca then conducted comprehensive staff training and has since provided brilliant support. The team are easy to contact with any queries we might have and have been a pleasure to work with.

6 5

8 8

2 2

EQUIPMENT SOLUTIONS

Before and after the refurbishment – Planmeca Promax® 3D Max was compact enough to fit into the small space.

The outcome – 8 months later Having eliminated the need to refer patients out for CBCT scans, we can now perform imaging during consultations and discuss the results with patients straight away. This has led to a quicker and more efficient service, while also having a positive influence on the profitability of the practice. As far as patients are concerned, the new CBCT is an extension of the services we already offered, providing them with more in-house. We have also marketed our CBCT scanning facilities as a new service available by referral and we receive referrals from several local practices. Upon reflection 8 months later, I wouldn’t do anything differently. I am most proud of the fact that we can take such high quality scans with a low radiation dose. Making the decision to invest in a CBCT is made all the easier with the assurance that you can see all the relevant anatomical structures at a fraction of the radiation dose of a traditional CT.

For my work with dental implants and oral surgery, this has been invaluable. For any other practitioners looking to invest in an in-house CBCT, I would strongly recommend researching radiation doses for equipment they’re considering. I would also advise looking at independent research rather than the manufacturer’s publications to get an unbiased and more accurate picture. Finally, I would recommend having a contingency budget when looking to renovate an old building in a conservation area, as there are always unexpected costs! Dr Ceri Owen-Roberts is the Principal of Elgin Park Dental Practice in Bristol, England. He has a particular interest in restorative dentistry and dental implants. Dr Owen-Roberts is a member of the International Team of Implantologists and a study club director for the Bristol region.

DR OWEN-ROBERTS BDS, MClinDent Rest/Cosmetic Bristol, England

h en r y sc h e i n .c o m .a u

6 5

EQUIPMENT SOLUTIONS

X-RAY PROCESSING SYSTEMS ANALOG VS DIGITAL

For many years, the dentist was reliant on the manual processing of x-ray films. Processing the analogue x-ray films were developed using a developing agent, followed by a fixing agent. The quality of film images was reliant on solid techniques and optimal chemicals. Small changes to the general process often created an image not very useful for clinical purposes and regularly a new and second image had to be taken resulting in time lost, extra x-ray exposure to patient and associated costs. Films were to be adequately stored manually for each patient. All this before any consideration is given to the handling, storage, and disposal of hazardous chemicals. Some years ago, the first digital PSP x-ray scanning device was released and has fast become an important device for all dental practices. The introduction of a digital system has reduced time spend getting images to chairside and hence improved workflow greatly. In broad terms, all digital systems reproduce the analogue system featuring all sizes of plates like the old analogue systems. Most common film sizes are 0, 1, 2, 3, and 4. The plates are affordable, re-useable for many scans and very easy to use. The current scanner range on the market connects easily to most imaging and patient’s administration software systems. The individual image processing, manipulation and archiving is achieved via specific software or a common TWAIN interface link. Choosing your next PSP scanner must include several considerations.

6 6

1 3 0 0

6 5

8 8

2 2

EQUIPMENT SOLUTIONS

Throughput requirements Consider your clinic size and current workflow will be very important choosing your next scanner. Most PSP systems are supplied with a one scanning track systems where others might have two or even up to four scanning tracks, which may be used at the same time.

Intra Oral film size do I require? Different branded scanners are available with different range of film sizes. Please consider, which size you use daily as well as the ‘occasional’ bitewing. Some scanners are available with just a few film sizes I.E. (0, 1 and 2) and will not produce a bitewing view. Other scanners will use two size 3 plates by stitching two images. There are however, options where a standard size 4 plate for an instant bitewing digital image.

Software and interfacing to patient data management systems? To take full advantage of the PSP scanner capacity to process digital images it is critical you consider how the unit will fit into your current imaging software and/or patient data management system. How many surgeries can be interfaced to my new scanner, WLAN or perhaps a wired network interface is available? How will the images be stored/transferred in the event of a network break down? Do I need a system with an onboard memory back-up?

Scan times & image quality – fast scanning time is not equal to best image quality The scan time is the time from insertion of image plate until scanning of the image data is completed depending on the image plate format and pixel size. The time for the image is significantly dependent on the computer system and its utilisation. Often a scanning time of 5.5 seconds will not generate a clinical acceptable image to facilitate optimal patient treatments.

User interface Scanners offered vary in terms of user interface options. Basic models will have a simple on/off button and plate is scanned and all data manipulation carried out on an associated PC or laptop. However, to improve workflows scanners are initiated from operatory PC, additional patient data added via a large, high-resolution touchscreen display scanner interface. Such feature will empower operators to select tasks, carry out the scan and perform a diagnosis.

Scan here to find out more

h en r y sc h e i n .c o m .a u

6 7

DIGITAL SOLUTIONS

DIGITAL WORKFLOW FINALISATION OF THE DEFINITIVE REHABILITATION

Treatment plan and digital impression Third part of a series published in the earlier two editions

In our first two articles on this Full Digital Workflow Case (published in DT issue 136 and 137) we covered the implant planning and placement phases as well as the primary and secondary phases of temporization using a full digital workflow including optimized scan strategies and 3D printing. In this third article, we will discuss the design and fabrication of the definitive restorations in lithium disilicate and zirconia, demonstrating the advantages of the digital workflow for fast, simplified and accurate planning.

The full series of digital scans were then sent to the ceramist along with all the pertinent laboratory prescription and digital shade images necessar y to complete the definitive restorations in this rehabilitation. The “second phase” provisional restorations were then recemented using a provisional cement (for natural tooth abutments) and re-inserted and torqued to the manufacturer’s recommendation (for implant-based provisionals).

Following a period of 3-months to allow the healing of the gingival tissues and development of the emergence profiles around the implant fixtures and the tooth 15 pontic sites, the final phase of converting the provisionals to the definitive restorations was undertaken. No addition or adjustments were required to the contours developed by the provisional implant restoration at tooth posititions 11 and 21 during the 3-month period.

The final goal of the rehabilitation was to restore the natural anterior teeth with bonded lithum disilicate based restorations. A monolithic Zirconia crown was utilized to restore tooth 24, the endodonticallytreated upper left premolar. Screw-retained layered Zirconia restorations bonded to ti-bases were planned for the restoration of the single unit implant restorations and the 3-unit implant supported bridge on the upper right quadrant.

A decision was made, with the patient’s approval, to replicate the aesthetics of the second phase printed provisional restorations (figs. 1a & b). In addition, the occlusal scheme tested in the provisional phase and providing for a mutually protected occlusion was also to be replicated on the definitive rehabilitation.

CAD design The simplicity of the final ceramic fabrication comes from the prior digital planning and the utilization of a full digital workflow. As there were no changes planned to the aesthetics, the anatomical shape of the teeth and functional requirements from the temporary prosthesis, the redesign of the definitive restorations in the CAD software was not necessary. Only minor changes to the work order made in the 3Shape Dental Designer was indicated.

The master digital impression was then completed utilising the “MAK optimized scan path” as described in detail in part two in this series of articles (Dental Technologies issue 137).

6 8

1 3 0 0

6 5

8 8

2 2

DIGITAL SOLUTIONS

Figs. 1a & b: It was decided that the printed secondary phase provisionals would serve as a basis for the design of the definitive restorations

Changes to the CAD design done for the definitive restorations The positions 11 and 21 have been changed to titanium custom abutments instead of using the Easy Temp Abutments (Biohorizons) that were used in the temp phase. Due to the shape of the Easy Temp Abutment, there were some thickness compromises in the temp phase mostly in the palatal contours of the 11 and 21. By using the Custom Abutment it is possible to maintain suppor t for the ceramic restoration, maintain the bond and maximize the thickness of the ceramic (fig. 2).

The choice of custom abutments was also driven by the necessity to narrow the emergence profile of the restorations, which will, in turn, maximize the tissue stability and improve the emergence profile of the implant retained restorations (fig. 3). Designing the margins subgingival by about 1-1.5 mm from all aspects is important to ensure that no metal isvisible. In addition, as the ceramic is cemented to the titanium abutment in the lab using Multilink Hybrid Abutment HO 0 opaque resin cement, clean-up after the cementation procedure is not an issue (fig.4).

Emergence profile design for the abutment for the upper right and left central incisor

Compromises to the minimum thickness in the temporary or provisional restorations due to the shape of the Easy Temp Abutmen

See the full article Ideal design of the custom abutments

MR BRAD GOBLAR

DR. ANDREW CHIO

DR ANTHONY MAK

Dental Technician

BDSc. (Melb)

Dentist BDS, Grad Dip Clin Dent (Oral Implants) (USyd)

h en r y sc h e i n .c o m .a u

6 9

PROSTHETIC SOLUTIONS

CLEAN DENTAL RESTORATIONS QUICKLY & EFFECTIVELY

Wearers of partial or full prosthetic restorations have always had high demands in terms of prophylaxis, aesthetics and oral comfort or wellbeing. And more and more patients would like their “false teeth” to be treated in the same way as their “natural teeth”. Professional cleaning of restorations is therefore an important component in individual prophylaxis.

It has never been attractive to go around with bad breath or an unsightly restoration, especially not nowadays. Many patients find it easier to understand the need to improve acceptance, attractiveness and quality of life.

Prof. Gutowski, what in your experience are the consequences of inadequate denture care? The formation of bacteria, plaque and calculus with their known effects. There is also inflammation at the denture base, impairment of taste and taste sensitivity, incidentally this also happens if the denture is not completely clean. It is therefore particularly important to ensure complete cleanliness. Further spreading to other organs also occurs, though this is very rare.

Which types of equipment do you normally use for cleaning dentures? We have been using the SYMPRO high-performance cleaning unit for some time.

While going to the hairdressers or inspection of the car is regarded as normal, it is still very difficult to convince many patients about the necessity of increased prophylaxis and cleaning.

Why do you use this unit in particular? It has proved to be effective at cleaning dentures. Extensive tests have convinced us of its advantages. Our dental assistants are very happy with the unit and they have to clean the dentures and know what they are talking about. The unit is also very easy to operate. What more can you ask for.

This was still very pronounced a few years ago. Nowadays, however, the situation has changed significantly. Not everyone responds to the undoubtedly sound medical reasons given by the dentist. Often the very positive effect on their normal life and living environment simply has to be explained to the patients.

7 0

1 3 0 0

6 5

8 8

2 2

PROSTHETIC SOLUTIONS

What exactly does quicker mean? Denture cleaning only takes a maximum of 20 to 30 minutes in our practice, the patient can then go home again with a clean denture. How do your patients react to this?

How often do your patients attend the practice for denture cleaning? Wearers of fixed-removable and full dentures visit the practice regularly, approximately every 6 months. The denture is then cleaned professionally in the practice.

They are pleased of course, who likes to wait for a long time. In addition, those patients who get their denture back after the first cleaning notice that they could never have cleaned the denture so well themselves and always come back at certain intervals to get their denture cleaned again. What do you expect from effective denture cleaning? Medically: cleaning in regions that are difficult to access. Technically: smooth surfaces. After the cleaning procedure the denture must be perfectly clean! All accretion must be removed, as it could irritate the mucosa and cause inflammation and even distorted taste perception. It is also important to clean the mucosa, as otherwise it could lead to the ping-pong effect.

Watch the video

PROF. DR. ALEXANDER GUTOWSKI Schwäbisch Gmünd, Germany

h en r y sc h e i n .c o m .a u

7 1

PROSTHETIC SOLUTIONS

THE PATIENT’S NEED: ECONOMICS, AESTHETICS & FUNCTIONALITY

Listening to what patients want and need is a crucial factor for a successful rehabilitation. When it comes to dentures, many older patients are looking for an economic solution. On the other hand, what they don’t want, is a denture that lacks functionality and aesthetics. The following user report profiles how to accomplish efficient and economic aesthetics and fuctionality with an established treatment protocol and denture teeth of choice.

partial denture in the lower to guarantee aesthetics and functionality for an ideal price-performance ratio.

The patient’s situation A 72 year-old female patient presented in the office because she could not eat properly with her removable rehabilitations. The partial denture in the lower jaw broke several times and was uncomfortable and unstable. Because of that she stopped wearing it. Despite the age-appropriate bone atrophy, the remaining teeth, 32 and 33, did not show any signs of inflammation. Tooth 32 had a mobility of one. The patient wanted to keep both teeth and refused implants, which would have distributed the forces more evenly. The disadvantages of an uneven load and the accelerating effect on her remaining teeth were explained. In case of necessary extractions in a later stage, an easy denture teeth addition to the new partial denture could be provided, which was satisfactory to the patient. She was currently only using the full denture in the upper, which did not function well, as the occlusal forces were unbalanced. She desired an improvement of aesthetics and eating conditions with new rehabilitations. Her limited budget made an economic solution necessary. Based on these factors, VITA Multi Functional Teeth (VITA MFT) were chosen for the new full denture in the upper and a

7 2

1 3 0 0

Pretreatment After anatomic impressions of the upper and lower jaw, models were fabricated on which individual trays were created for the mucodynamic impression. Master models were manufactered to be able to produce fitting bite registration plates with a wax rim to record the position of the mandible in relation to the maxilla and to transfer the midline, the canine position, the incisal length and expansion of the buccal corridor. According to the clinical bite registration, the two master models were articulated and the model analysis was performed. Set up VITA MFT Anterior was used for the set up in the anterior area. For a budget denture tooth, the anterior sets are very aesthetic. They are designed naturally in morphology and texture. The anatomical structure is simulated with neck, dentine and enamel layers, which leads to a three-dimensional play of light and color. Tooth axis and coordinated angle characteristics, according to the aesthetic rules, make a quick match of the front teeth possible.

6 5

8 8

2 2

PROSTHETIC SOLUTIONS

Fig. 1: The remaining teeth, 32 and 33, did not show any signs of inflammation.

Fig. 2: The set up in the aesthetic zone with VITA MFT Anterior.

Fig. 3: The lingualized VITA MFT Posterior during the set up.

Fig. 4: Easy centric with buccal contacts in the molar region.

Fig. 5: The wax set up gave guidance during the clinical try in.

Fig. 6: The lingualized VITA MFT Posterior provides more space for the tongue.

Due to the position of the remaning canine and incisor, all lower teeth were used in addition to the natural incisor 32 to provide stability while eating with the new denture. So altogether, there were five lower central incisors established. The set up was performed edge to edge to the remaining natural teeth to improve the aesthetics of the upper smile line. In the molar region, the lingualized VITA MFT Posterior easily enabled finding the centric position and establishing buccal contacts, due to the multifunctional occlusal surface design. The lingualization of the teeth offered more space for the tongue and a more stable function on the atrophied jaw ridges. Extra care was also taken during the contouring of the lower lingual aspect to implement space and free movement of the tongue.

During the try in, a final bite registration was taken with the set ups in order to recheck static and dynamic occlusion in the articulator. Polymer transfer and outcome After a succesfull clinical try in and final anatomical contouring, the rehabilitations were transferred into polymer. First, the set ups were duplicated with hydrocolloid. Then the teeth were cleaned, conditioned and repositioned in the hydrocolloid index. Before the flasking of the denture base with the auto-polymerizing and pourable Castdon Resin, internal colors of the DentureArt System (both Dreve Dentamid, Unna, Germany) were applied into the flask to simulate the appearance of the gingival anatomy. After the polymerization, finishing and polishing was performed.

h en r y sc h e i n .c o m .a u

7 3

PROSTHETIC SOLUTIONS

Fig. 7: View on the final upper wax set up in the molar region.

Fig. 8: The finally contoured wax set up in the upper jaw.

Fig. 9: Altogether five lower central incisors were established to offer stability.

Fig. 10: The palatal anatomy was also reproduced meticulously.

Fig. 11: Both wax set ups in the articulator.

Fig. 12: The upper and lower rehabilitations after their transfer into polymer.

Fig. 13: Gingival anatomy was simulated with internal colors.

Fig. 14: The new rehabilitation appeared very natural intraorally.

The new rehabilitations were inserted intraorally and checked by the practicioner and the patient. Both were very satisfied with the lifelike appearance and functional integration.

VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

The patient’s requirements of an economical, aesthetic and functional rehabilitation were all met.

DANIEL LAVRIN Dental Technician and Denturist

7 4

1 3 0 0

Fig. 15: The lifelike appearance and the functional integration of the rehabilitations.

6 5

8 8

2 2

NEW PRODUCTS SEE THE LATEST INNOVATIONS FROM OUR LEADING GLOBAL SUPPLY PARTNERS

h en r y sc h e i n .c o m .a u

7 5

NEW PRODUCTS

CLEARFIL MAJESTY™ ES-2 UNIVERSAL INTELLIGENT SIMPLIFICATION

Clearfil Majesty™ ES-2 Universal is a truly Universal composite with simplified shade selection, suitable for both anterior and posterior restorations. With a Universal shade concept, Clearfil Majesty™ ES-2 Universal has a single universal shade for posterior restorations (Universal) and a choice of two Universal shades for anterior restorations, Universal Light or Universal Dark. For anterior cases that require high value/lightness, we also have a dedicated white shade, Universal White. Clearfil Majesty™ ES-2 Universal combines exceptional aesthetics with unprecedented simplicity and superior mechanical properties and is indicated for class I,II, III, IV and V cavities. No blocker or opaquer is required in either the anterior or posterior region due to the integration of Kuraray Noritake Dental’s unique Light Diffusion Technology (LDT). As a result, Clearfil Majesty™ ES-2 Universal integrates easily and seamlessly into the surrounding tooth structure and preparation margins become virtually invisible.

Available in Syringes or PLT’s • • • • • • •

Simplified shade selection: 4 shades Single shade technique No blocker or opaquer required Indicated for class I, II, III, IV & V Good optical integration Superior mechanical properties Highly aesthetic results that last Scan the QR Code to watch Simplifying Posterior Composite Restorations – The bread and butter of your daily practice

CLEARFIL Majesty™ ES-2 Universal is a true game-changer, as it provides the perfect match between simplicity and aesthetics.

7 6

1 3 0 0

6 5

8 8

2 2

NEW PRODUCTS

EDGEFILE X7 COMING SOON - NEW STERILE PACKAGING

EdgeFile X7 is the #1 selling EdgeEndo NiTi system. It has been recognised globally as a proven solution. EdgeEndo’s proprietary FireWire™ Heat-Treating process gives the EdgeFile X7, “Canal Contouring Technology,” making the files extremely flexible and reducing the shape memory and “bounce back” effect of other NiTi files. The flexible EdgeFile X7 closely follows the anatomy of the canal without straightening out, reducing the risk of ledging, transportation, and perforation. The flexible shaft reduces the need for excessive straight-line access, allowing more tooth structure to be preserved. It’s tight pitch flutes and flexibility has made it one of the greatest systems that is able to fit the technique of most dentists. Offered in .04 and .06 tapers in sizes 17-45 and lengths 21mm, 25 mm and 29mm. Customer reviews rank the X7 as the most flexible, versatile, and cyclic fatigue (file separation) resistant portfolio from EdgeEndo. • Parabolic Cross Section - Non-Cutting Tip • Constant Taper - Variable Pitch • Has a positive rake angle • Does not have radical lands • Electropolished Manufacturing Process • “FireWire” Heat Treatment

Find out more Watch Henry Schein TV Episode Endodontic Innovations

h en r y sc h e i n .c o m .a u

7 7

NEW PRODUCTS

ULTRA SAFETY PLUS TWIST THE NEW GOLD STANDARD IN SAFE INJECTIONS

Septodont, the world leader in pain management, has always been at the forefront of dentistry, developing, manufacturing and distributing a wide range of high quality dental products all over the world. Now, its French affiliate 100% dedicated to dental needles continues to innovate with Ultra Safety Plus Twist, the upgrade of its gold standard safety injection device. This comes as an important evolution to further help dental professionals to efficiently protect themselves against needle stick injuries (NSI)

Ultra Safety Plus Twist: a safe and easy device Ultra Safety Plus has become the gold standard safety device, demonstrating its efficiency to protect the dentist and its staff from needle stick injuries and comply with the latest regulations. New Ultra A LONG-PROVEN Safety Plus Twist is safer and easier with its new EFFICACY intuitive patented locking system: only two easy steps are needed for a secure assembly. Also, the A study demonstrated that when introduced in a dental school, Ultraas Safety Plussterile was a single use or with device is available either the key success factor for avoiding needle stick injuries. a sterilisable handle.

Needle stick injuries: a significant risk Among the 35 million health workers, the World Health Organization estimated that 3 million suffered from percutaneous exposures to bloodborne pathogens each year.1

FREQUENCY OF NEEDLE STICK INJURIES FREQUENCY OF NEEDLE STICK INJURIES

The needle stick injuries represent significant risks on:

•

Health: Among health care workers, about 40% of HBV and HCV infections and 2.5% of HIV infections are due to occupational sharps exposures.1

•

Cost: Costs for a healthcare organisation when a needle stick injury occurs are about $747 (range between $199 and $1,691).2

•

Legislation: Many health care agencies put in place legislations to prevent needle stick injuries requiring the implementation of safety procedures, the use of safety devices and the prohibition of the recapping of needles.

ULTRA SAFETY PLUS INTRODUCTION ULTRA SAFETY PLUS INTRODUCTION

YEAR 1

YEAR 2

YEAR 3

YEAR 4

YEAR 5

With UltraUltra Safety Plus,Plus, needle stick injuries With Safety needle stick injuries decreased from an decreased an average of 11.8 to 1,000,000 0 injuries per averagefrom of 11.8 to 0 injuries per hours worked(1) (1) 1,000,000 hours worked (1) J.M Zakrzewska et al. Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J 2001 ; 190; 88-92.

BROCHURE 3 volets SEPTODONT v16 GAMME XL OK 23/09.indd 6

7 8

1 3 0 0

6 5

8 8

2 2

24/09/2020 10:19

safe & easy > Protects you and your staff from needle stick injuries > Complies with latest regulations > Intuitive device > Available with either sterile single use or sterilisable handle

NEW PRODUCTS

Passive or active aspiration: security for the patient Transparent barrel aspiration is clearly visible

Sliding protective sheath: protection from needle stick injuries

Twodifferent different positions: Two positions: first Holding Position (reversible) ﬁrst (reversible) ﬁnal final Holding Locking Position Position (irreversible) Locking Position (irreversible)

BROCHURE 3 volets SEPTODONT v16 GAMME XL OK 23/09.indd 5

24/09/2020 10:19

•

Protects you and your staff from needle stick injuries

•

Available with either sterile single use or sterilisable handle

• •

Complies with latest regulations

•

Easy and secure lock

Intuitive device

References 1. WHO, The world health report 2002 - Reducing Risks, Promoting Healthy Life, 2002. 2. Mannocci A, De Carli G, Di Bari V, et al. How Much do Needlestick Injuries Cost? A Systematic Review of

the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel. Infect Control Hosp Epidemiol. 2016;37(6):635–646. doi:10.1017/ice.2016.48.

About Septodont For over 80 years Septodont has been a global influence in manufacturing dental materials and local anesthetics for the dental community. Today they are a leader in pain management with a presence in over 150 countries with regulatory approvals to match. Septodont has 8 manufacturing facilities on 4 continents; Canada, United States, India, France (3) and Brazil (2).

h en r y sc h e i n .c o m .a u

7 9

NEW PRODUCTS

CROWN-BRIDGE TECHNIQUE SHAX

The best, most innovative and efficient cutter ever created by Komet.” With its unique blade geometry, this new generation of cutters offers an unprecedented combination of maximum substance removal and incredibly smooth surfaces.

Crown-bridge || SHAX Crown-bridge Crown-bridge technique technique SHAXtechnique | SHAX The performance properties of the SHAX cutters are so unique and technique | SHAX Crown-bridge efficient that they do not require a coating. Like that, the customer saves unnecessary costs.“The best, most innovative and

Substance removal “The best, most innovative and “The best, mostever innovative Substancewhile removal efficient cutter createdand by “Hungry”, creating efficient cutter ever created by efficient cutter ever created by “Hungry”, while creating Komet.” smooth surfaces in order Komet.” Range of application: Komet.” smooth surfaces in order “The Substance removal to facilitate subsequent “The best, best, most most innovative innovative and and Substance removal to facilitatewhile subsequent • Effective work on non-precious metal and model cast alloys efficient cutter ever created by “Hungry”, creating With its unique blade geometry, this polishing. With its unique blade geometry, this while creating efficient cutter ever created by “Hungry”, With its unique blade geometry, polishing. • Crown bridge technique Komet.” smooth in new generation of cutters offers this an The inteligent combination new generation of cutters offers an surfaces Komet.” smooth surfaces in order order generation combination of cutters offers The inteligent combination • Model cast technique new to facilitate subsequent unprecedented of an fine blades unprecedented combinationof toofcoarse facilitateand subsequent unprecedented combination ofand of coarse fine blades With blade geometry, this polishing. maximum substance lead to fineand surfaces. maximum substance removal and With its its unique unique blade removal geometry, this polishing. maximum substance removal andan lead to fine surfaces. new generation of cutters offers The inteligent combination incredibly smooth surfaces. Substance removal “Hungry”, while creating smooth surfaces in incredibly smooth surfaces.Unique new generation of cutters offers an The inteligent combination toothing incredibly smooth surfaces. of unprecedented combination of coarse and fine blades order to facilitate subsequent polishing. unprecedented combination of Unique toothing of coarse and blades Every blade is fine unique, none maximum substance removal to fine surfaces. properties the of the maximum substance removal and The inteligent combinationThe ofperformance coarse and fineofand blades lead to fineThe performance propertieslead Every blade is unique, lead to fine surfaces. is like the other. Tooth none height The performance properties of the incredibly smooth surfaces. SHAX cutters are so unique and SHAX cutters are so uniqueand incredibly smooth surfaces. isand likedepth thetoothing other. Tooth height surfaces. Unique are constantly SHAX cutters are so unique and Unique toothing efficient that they do not require a efficient that they do not require a are and depth constantly Every different. efficient that that, they properties do require a Every blade blade is is unique, unique, none none The of coating. Like thenot customer coating. Like that, the customer The performance performance properties of the the different. Unique toothing is like Tooth coating. Like that, the customer is like the the other. other. Tooth height height Economic efficiency SHAX cutters are so unique and saves unnecessary costs. saves unnecessary costs. and depth are constantly SHAX cutters are so unique and Economic efficiency saves unnecessary costs. and depth are constantly The user saves precious time efficient that the they do do not require require Every blade is unique, none is like other. Tooth efficient that they not aa height and depth different. The user saves precious time different. thanks to the outstanding coating. Like that, the customer are constantly different. coating. Like that, the customer thanks tocapacity the outstanding Range of application: Economic efficiency removal of the cutsaves costs. Range of application: Economic efficiency saves unnecessary unnecessary costs. Range of application: removal capacity of surfaces the cutThe user saves precious time ter and smooth • effective work on non-precious The userthe saves precious time • effective work on non-precious Economic efficiency ter and to the smooth surfaces • metal effective on cast non-precious andwork model alloys thanks the outstanding created. SHAX cutters are metal and model cast alloys thanks to the outstanding metal and model SHAX cutters are • crown bridge technique Range of The user saves precious time to cast the alloys outstanding removal• crown bridge techniquecreated. removal capacity ofbythe the cutalso distinguished their Rangethanks of application: application: removal capacity of cutcrown bridge technique • model cast technique also distinguished by their • model cast technique ter and the smooth surfaces capacity of the cutter and the smooth surfaces created. SHAX • model effective work on non-precious non-precious extremely service life. ter and thelong smooth surfaces effective work on • cast technique extremely long service life. metal model cast created. SHAX cutters are cutters are also distinguished byand their extremely metal and model cast alloys alloys long service life. created. Patent SHAX cutters are • crown bridge technique also distinguished by • crown bridge technique also distinguished by their their Patent • Innovative, revolutionary, • model model cast cast technique technique extremely long service life. Patent extremely long service life. Innovative, revolutionary, patented blade geometry patented blade geometry Patent that cannot be copied. Patent Innovative, revolutionary, patented blade geometry that cannot be that cannotrevolutionary, be copied. Innovative, Innovative, revolutionary, copied. patented blade patented blade geometry geometry that that cannot cannot be be copied. copied.

10009624v001_PIC_EN_SHAX_A5.indd 3 10009624v001_PIC_EN_SHAX_A5.indd 3

10009624v001_PIC_EN_SHAX_A5.indd 3

10009624v001_PIC_EN_SHAX_A5.indd 3 10009624v001_PIC_EN_SHAX_A5.indd 3

8 0

16.12.20 11:27 16.12.20 11:27

1 3 0 0

6 5

8 8

2 2

Substance rem “Hungry”, while smooth surface to facilitate sub polishing.

The inteligent c of coarse and f lead to fine sur

Unique toothi Every blade is u is like the other and depth are c different.

Economic effi The user saves thanks to the o removal capaci ter and the smo created. SHAX also distinguish extremely long

Patent Innovative, revo patented blade that cannot be

Competitor B (H79)

SHAX-Cutter (H79)

Competitor A (H79)

Competitor A coated (H79)

Fine toothing to create smooth surfaces

(Average of 8 measurements)

Substance removal of non-precious metals in g

NEW PRODUCTS

Coarse, hungry toothing for effective substance removal

Time Source: Testlab Komet, machine cutting test 2020

X Performance Due to its unique blade geometry, SHAX outperforms other existing cutters for non-precious metals up to 34% Useful hints

H261SHAX.104.023

H251SHAX.104.060

H250SHAX.104.040

H139SHAX.104.023

H138SHAX.104.023

H129SHAX.104.023

H89SHAX.104.040

H79SHAX.104.040

H77SHAX.104.023

H73SHAX.104.014

This new generation of tungsten carbide cutters was primarily developed for work on non-precious metals. The active part is provided with a unique blade geometry where each tooth has its own individual height and depth. These cutters remove large amounts of material while creating a perfectly smooth finish on metal surfaces.

Technical specifications: • Recommendation for use: 20,000 rpm Work with low pressure.

h en r y sc h e i n .c o m .a u

8 1

NEW PRODUCTS

TRIMMING OF TISSUE | CERATIP DURABLE INSTRUMENT MADE OF HIGH-GRADE CERAMICS

Komet has expanded its CeraLine range of innovative white instruments developed by adding the tissue trimmer CeraTip in cooperation with Prof. Dr. Sami Sandhaus. The CeraTip is made of a mixed ceramic composed of zircondioxide oxide partly stabilized by yttrium and aluminium ceramic. This high-performance material lends the CeraTip all the properties the user needs for perfect trimming of the gingiva

There is no glued-in tip that might detach itself from its metal support prematurely. We provided the CeraTip with a black laser mark so that it stands out more against the mainly white environment in the dental practice.

Advantages at a glance:

The CeraTip is suited for a vast range of applications in mucosa surgery, a few examples of which are listed on the reverse of this page. It constitutes an ideal alternative to scalpels and electrosurgery. Manufactured in one piece, the CeraTip offers a range of advantages to the user. Thanks to its ergonomic construction, all fields of gingivectomy can be covered with just one instrument. Unlike many other trimming instruments, the CeraTip is completely free of metal, which means that there is no metal support that might get in the way or block access to the operative site. Another advantage is the instrument’s long service life:

8 2

1 3 0 0

6 5

•

Reduced bleeding because the tip of the instrument causes thermal

•

Coagulation sealing the blood vessels

•

Durable one-piece construction to prevent premature detachment from a metal support

•

Ergonomic construction – with no metal support to get in the way, the CeraTip can cover all indications

•

Metal-free, therefore biocompatible and free of corrosion

8 8

2 2

NEW PRODUCTS

Indications:

Recommendations for use:

The CeraTip is suitable for use in various sectors of mucosa surgery, such as:

•

Work gently in intermittent mode, exerting little pressure. Rotate instrument at an optimum speed of (300.000 – 450.000 rpm.

•

Use without cooling to allow the tip of the instrument to generate the kind

•

Of heat during rotation that is required to cause thermal coagulation, i.e. to model the gingiva with a minimum of bleeding.

•

Always clean the instrument with a nylon brush. Metal brushes might leave discoloration caused by friction on the instrument.

•

Exposing intra-osseous implant sites (fig. 1)

•

Dilation of the sulcus following a crown core preparation (fig. 2)

•

Exposing deep cavities in the neck of the tooth

•

Exposing impacted teeth

•

Papillectomy / Removal of hyperplastic gingiva

Contra-indications Do not use instrument as a lever and avoid all activities that could lead to jamming of the instrument.

Available exclusively from Henry Schein

KT.314.016

Kit 4561

h en r y sc h e i n .c o m .a u

8 3

NEW PRODUCTS

BL- B KONDENSER NEW PRODUCT

BL-B Kondenser Customised Condensers Are available individually or as a full set of 4. Handles are colour coded by size. The flexible end is made from nickel titanium and can be used for curved canals. The other end is made of stainlesssteel and is ideal for compaction in the coronal and middle thirds of the canal. • • • •

8 4

Handles are colour-coded by size allowing faster selection of the desired condenser. Lightweight design and handles are designed to fit comfortably into the natural grip of the user. Increased control with dimpled grips allows the condenser to be held firmly, increasing the amount of control for the user. Autoclavable

1 3 0 0

6 5

8 8

2 2

Scan to see Tips for warm vertical condensation

NEW PRODUCTS

A BRIGHTER MORE CONFIDENT SMILE IN 5 DAYS

New Pola Light: 9.5% Hydrogen Peroxide Kit - The Pola Light advanced tooth whitening system combines Pola’s award winning whitening formula, with targeted LED technology. And all from the comfort of your home. • • • • •

Fast acting, delivering you whiter teeth in 5 days Formulated to safely remove long term stains Returns your smile to your whitest natural shade possible Extra hydration to minimise sensitivity Remineralization to strengthen your teeth

Pola Light, an advanced tooth whitening system combines Pola’s award-winning whitening formulas, with a LED mouthpiece to help accelerate the whitening procedure is now available in 9.5% hydrogen gel. Pola Light is an easy and comfortable take home kit, with treatment options from just 20 minutes a day. The gels are fast acting and are formulated to safely remove long term stains in as little as 5 days. The high viscosity, neutral pH tooth whitening gel ensures the greatest patient and a unique blend of soothers, conditioners and high-water content also assist in reducing sensitivity. The Pola LED mouthpiece is dual arch and a universal size, removing the need for chair time and custom trays – saving both the patient and the clinician time.

The Pola tooth whitening range has successfully treated millions of patients worldwide. SDI has an ongoing commitment to providing better tooth whitening solutions that are safe, simple and effective. Pola tooth whitening is an Australian innovation.

Pola Light 9.5% hydrogen peroxide kit contents: • 1 x Pola LED mouthpiece • 4 x 3g Pola Day tooth whitening syringes • 1 x USB charging cord • 1 x instruction guide with a shade guide. Pola Light system is also available in a 6% hydrogen peroxide gel kit that comes with a bonus inclusion of Pola Luminate Australia wide.

h en r y sc h e i n .c o m .a u

8 5

NEW PRODUCTS

EUROSEPT XTRA EVAC CLEANER NEW PRODUCT

The Henry Schein Eurosept Xtra Evac Cleaner is a two-component system (Daily and Weekly) for effective cleaning and maintenance of dental suction systems. Regular usage of the Daily/Weekly system helps remove blockages, by dissolving existing deposits, and preventing the build-up of odour causing biofilm in the suction lines. These products are aldehyde-free, phenol-free, and chlorine-free, to reduce their environmental impacts. Both components are in to obtain optimal results. Note

concentrate form and must be used as per the recommendations below that the two components are used on separate days.

Eurosept Xtra Evac Cleaner Daily Concentrate A low-foaming enzymatic cleaning concentrate, for daily cleaning and care of dental suction systems. Enzymatic cleaners effectively remove organic matter such as blood and saliva residue. Do not use on the days the Weekly Concentrate is used.

Eurosept Xtra Evac Cleaner Weekly Concentrate A foam-free, low pH acid cleaning concentrate, for removal of mineral deposits from dental suction systems. Phosphonates, widely in water treatment processes, is a key active in the Weekly Concentrate. Application on 2 days each week is recommended.

The range comprises of Eurosept Xtra Evac Cleaner Daily 1L or 5L & Eurosept Xtra Evac Cleaner Weekly 1L. Accessories available Eurosept Xtra Dosing Pump for 5L cannister & Eurosept Xtra Evac Delivery Bottle (shown above)

8 6

1 3 0 0

6 5

8 8

2 2

NEW PRODUCTS

DIGITAL SOLUTIONS

AUSTRALIA’S LARGEST ONLINE STORE FOR DENTAL PROFESSIONALS

EUROSEPT XTRA EVAC CLEANER NEW PRODUCT

ONLINE

concentrate form and must be used as per the recommendations below that the two components are used on separate days.

TAKE ADVANTAGE OF THESE EXCLUSIVE BENEFITS •

Speed up your consumable ordering

•

Select from over 30,000 products

•

Track & Trace deliveries

•

Ordering templates to save time & money

•

View your backorder status

•

Pay your account quickly Online

•

Inventory Management Solutions

•

Online Live Chat - to resolve any questions

HENRY SCHEIN.COM.AU

YOUR GO - TO SITE FOR EDUCATIONAL CONTENT AND COURSES •

Webinars

•

Podcast

•

Clinical Videos

•

Henry Schein TV

Eurosept Xtra Evac Cleaner Weekly Concentrate

•

Clinical Articles & News

A foam-free, low pH acid cleaning concentrate, for removal of mineral deposits from dental suction systems. Phosphonates, widely in water treatment processes, is a key active in the Weekly Concentrate. Application on 2 days each week is recommended.

•

Latest In-Person Events & Courses

8 6

1 3 0 0

6 5

8 8

2 2

DENTAL EDUCATION HUB.COM.AU Clinical content from leading global dental manufacturers updated weekly

henry s chei n.com.au

8 7

1300 65 88 22 henryschein.com.au